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Ewing Sarcoma (ES)/Primitive Neuroectodermal Tumor (PNET)

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The most common sites of involvement are medullary cavity of long tubular bones (femur, tibia, humerus, fibula), flat bones of pelvis, vertebra, ribs, and clavicle. Radiographs show a destructive lesion with widening of medullary cavity. Reactive periosteal bone deposits perpendicular to the cortex (sun-ray appearance) are present mid-shaft in this image. When deposited in a concentric fashion, it creates an onion-skin appearance.

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