Partial surgical excision of ewing sarcoma in the lower mandible of an 11-year-old boy with dental malocclusion.

Introduction and importance: Ewing sarcoma (ES) is an uncommon and aggressive tumor that primarily affects children and adolescents, peaking in incidence between the ages of 10 and 20. Although it most frequently occurs in long bones and the pelvis, its presence in the lower mandible is extremely rare, creating notable challenges in both diagnosis and treatment. Case presentation: This report details an 11-year-old boy from a low-income background who was diagnosed with Ewing sarcoma localized to the lower mandible. Initially, he presented with ongoing pain and swelling, which were mistakenly attributed to dental problems, resulting in a delayed diagnosis. Imaging studies identified a permeative bone lesion, which was confirmed through biopsy to be Ewing sarcoma with the EWSR1-FLI1 fusion gene. The patient underwent partial surgical excision followed by a chemotherapy regimen. Unfortunately, he developed neutropenia and septic shock during treatment, leading to his eventual death. Clinical discussion: This case highlights the diverse clinical presentations of Ewing sarcoma, stressing the necessity for heightened awareness of malignant conditions in pediatric patients. It also discusses the socioeconomic factors that can delay diagnosis, underscoring the importance of raising awareness in underserved areas. A multidisciplinary treatment approach is essential, along with careful monitoring for complications. Conclusion: This case exemplifies the challenges in diagnosing and managing Ewing sarcoma in atypical sites such as the mandible. It emphasizes the need for early symptom recognition, addressing socioeconomic disparities and implementing comprehensive care strategies to enhance patient outcomes in pediatric oncology.