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Ewing sarcoma is a rare cancer that most often affects children and teenagers aged 10–20. It usually starts in the bone (about 87% of cases) and less commonly in nearby soft tissues such as muscle or cartilage. The most frequent locations are the pelvis, chest wall and long bones of the legs. In the United States, around 200 children and young adults are diagnosed each year. There are several related forms of Ewing sarcoma, including Askin tumor, extraosseous Ewing sarcoma and peripheral primitive neuroectodermal tumor (pPNET). These tumors share the same genetic origin and are treated as one disease group. At Sheba Medical Center, patients with Ewing sarcoma receive comprehensive, multidisciplinary care. As the largest medical center in the region, Sheba brings together internationally trained pediatric oncologists, orthopedic surgeons, radiologists and radiation oncologists to deliver personalized treatment plans. Each case is carefully evaluated to ensure accurate diagnosis, staging and the most effective therapy. Symptoms Persistent or intermittent bone pain Swelling, tenderness or a lump near the tumor Limping or reduced movement if a limb is affected Fever, fatigue, weight loss Unexplained fractures Advanced disease may cause shortness of breath or chest pain if the lungs are involved Diagnosis & Staging Diagnosis includes imaging (X-ray, MRI, CT, PET), biopsy, and molecular genetic testing to confirm the characteristic chromosomal changes. Disease is classified as localized, regional, metastatic or recurrent, which guides treatment decisions. Treatment Treatment typically combines chemotherapy, surgery and radiation therapy, with options such as targeted therapy, immunotherapy or bone marrow transplantation in selected cases. Sheba’s approach addresses both medical outcomes and quality of life. Prognosis When diagnosed early, outcomes are favorable. Localized Ewing sarcoma has a 5-year survival rate of up to 82%, while prognosis depends on stage, tumor size, location, age and response to therapy. Early expert care makes a critical difference in Ewing sarcoma outcomes.

What Is Moyamoya Disease? Moyamoya disease is a rare, progressive cerebrovascular disorder in which the main arteries supplying blood to the brain—particularly the internal carotid arteries—become narrowed or blocked. As blood flow decreases, the brain compensates by forming a network of small, fragile blood vessels at its base to maintain circulation. These abnormal collateral vessels are prone to bleeding and clotting, significantly increasing the risk of recurrent strokes and transient ischaemic attacks (TIAs). The term “moyamoya”, meaning “puff of smoke” in Japanese, refers to the characteristic appearance of these tangled vessels seen on cerebral angiography. Although moyamoya disease is more commonly diagnosed in children, it can also affect adults, often presenting with different symptoms and complications. Types of Moyamoya Disease Idiopathic Moyamoya Disease This is the primary form, with no identifiable underlying cause. Secondary Moyamoya Syndrome This form develops in association with other medical conditions, including: Neurofibromatosis Down syndrome Previous radiation therapy to the head Certain genetic or systemic disorders Symptoms of Moyamoya Disease Symptoms vary depending on the patient’s age and the severity of arterial narrowing. Common signs and symptoms include: Sudden weakness or paralysis, often affecting one side of the body Recurrent transient ischaemic attacks (TIAs) or strokes Severe or persistent headaches Seizures (more common in children) Cognitive impairment, including memory and learning difficulties Visual disturbances or sudden vision loss Speech problems, such as difficulty speaking or understanding language Involuntary movements, including chorea or dystonia When to Seek Emergency Medical Care Immediate medical attention is critical if stroke symptoms are suspected. Remember FAST: F – Face: Facial drooping when smiling A – Arms: Weakness when raising one or both arms S – Speech: Slurred speech or difficulty understanding T – Time: Call emergency services immediately Prompt treatment can be life-saving and reduce long-term disability. Causes of Moyamoya Disease The exact cause of moyamoya disease remains unknown, but several contributing factors have been identified: Genetic predisposition: The condition may run in families and is more common among individuals of East Asian descent Autoimmune conditions: Diseases such as lupus may be associated Environmental factors: Previous radiation therapy to the brain increases risk Complications and Related Conditions Progressive narrowing of cerebral blood vessels can lead to serious neurological complications, including: Recurrent TIAs Ischaemic stroke (cerebral infarction) Haemorrhagic stroke Developmental delays and learning difficulties in children Permanent weakness or paralysis Speech and language disorders Seizure disorders Emotional and behavioural changes, including anxiety, depression, and personality changes Can Moyamoya Disease Be Prevented? Currently, there is no known method to prevent moyamoya disease, as its underlying cause is not fully understood. However, proactive management can reduce complications: Regular neurological evaluations for early diagnosis Genetic counselling for families with a known history Maintaining vascular health through: Balanced nutrition Regular physical activity Avoidance of smoking Early detection and appropriate medical or surgical management are key to improving long-term outcomes.