Primary tracheal Ewing sarcoma.

Primary Ewing sarcoma of the trachea is an exceptionally uncommon malignancy that often presents with non-specific airway symptoms, leading to diagnostic delays. We report a woman in her early 30s with progressive cough, dyspnoea, hoarseness and stridor who was initially mismanaged as having common airway disease. Imaging revealed a near-obstructing tracheal mass, which was successfully excised bronchoscopically. Histopathology examination, immunohistochemistry and fluorescent in situ hybridisation confirmed the diagnosis of Ewing sarcoma with EWSR1 gene rearrangement. The patient was subsequently initiated on chemotherapy and is doing well on follow-up. This case underscores the importance of considering rare tracheal tumours in patients with persistent unexplained airway symptoms, the pivotal role of immunohistochemistry and molecular testing in diagnosis, and the value of bronchoscopic intervention for both airway relief and tissue diagnosis. Early recognition and a multidisciplinary approach are essential for optimal outcomes in such rare presentations.