Temporary Airway Stenting As a Bridge to Chemotherapy in Primary Mediastinal Ewing's Sarcoma With Critical Tracheal Compression: A Case Report Publisher



Farahani M M ; Mohammadi S ; Golkarami N ; Rezaei M ; Kiani A ; Seifi S
Source: Respiratory Medicine Case Reports Published:2026

Abstract

Background: Primary mediastinal Ewing sarcoma is an exceptionally rare and aggressive malignancy that may rapidly lead to life-threatening compression of mediastinal structures. Management is particularly challenging when critical airway obstruction is present. Case presentation: A 38-year-old woman presented with progressive dyspnea and cough. Chest imaging revealed a large right paratracheal mediastinal mass causing severe extrinsic tracheal compression with near-complete airway narrowing. Diagnosis was established by EBUS-TBNA, and histopathological and immunohistochemical findings were consistent with Ewing sarcoma. Given the imminent risk of respiratory failure, diagnostic EBUS-TBNA and airway stenting were performed during the same procedural session under general anesthesia. A fully covered self-expanding metallic stent was placed to secure the airway and enable safe initiation of systemic chemotherapy. The patient subsequently received VAC/IE chemotherapy. Follow-up imaging demonstrated marked tumor regression, and the stent was successfully removed after three months. At 6-month follow-up, the patient remained asymptomatic without clinical or radiological evidence of recurrence. Conclusion: Temporary tracheal stenting may serve as an effective bridge to definitive therapy in selected patients with mediastinal Ewing's sarcoma and critical airway obstruction. Multidisciplinary management is essential in such high-risk cases. © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/