Clinical Deception: When Abscess Is Not Abscess
This case highlights a dangerous diagnostic pitfall. The patient had elevated inflammatory markers (WCC 11.3, CRP 212) and a visible retropharyngeal bulge on endoscopy—classic signs of infection. Yet, there was no fever, no fluctuant mass, and no pus on incision. For clinicians, the absence of these typical infectious features in a progressive upper airway obstruction should raise immediate suspicion of malignancy, even when inflammation markers are present.

Diagnostic Key: Pathology and Genetics
Diagnosing small round blue cell tumors in the head and neck is challenging, as imaging lacks classic ES findings like bone destruction or periosteal reaction. Definitive diagnosis relies on immunohistochemistry (CD99 positivity) and genetic testing (EWSR1 rearrangement). Importantly, fine-needle aspiration often provides insufficient tissue; core or open biopsy is preferred. This case underscores that a high-grade malignancy like ES can hide behind a benign-looking, non-ulcerative swelling.

Treatment Reality and Future Hopes
Complete surgical resection in the head and neck is difficult due to anatomical complexity and functional risks. Chemotherapy and radiotherapy remain the backbone of treatment, but advanced-stage adult patients still face a grim prognosis. Emerging techniques such as endoscopic transnasal surgery and proton beam therapy offer potential for better local control with fewer complications. Nevertheless, early recognition and multidisciplinary management are critical—because in atypical locations and ages, the rare diagnosis must not be overlooked.

The work titled “Extraosseous Ewing’s Sarcoma Mimicking a Retropharyngeal Abscess: A Rare Case”, was published on Eye & ENT Research (published on March 5, 2026).
DOI：10.1002/eer3.70032