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Salama H, Abu-Hilal LH, Idkedek M, Kharousha A, Abulihya M, Nimer H. Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature. J Med Case Rep 2024; 18:144. [PMID: 38459600 PMCID: PMC10924417 DOI: 10.1186/s13256-024-04384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/14/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Spinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management. CASE PRESENTATION We report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient's sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3-L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted. CONCLUSIONS Intradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.
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Affiliation(s)
- HusamEddin Salama
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Lila H Abu-Hilal
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Mayar Idkedek
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Abdalwahab Kharousha
- Department of Neurosurgery, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine
| | - Mohand Abulihya
- Department of Pathology, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine
| | - Hafez Nimer
- Department of Neurosurgery, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine
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Chen J, Zheng YF, Tang SC, Zhao YQ, Chen J, Wang Y. Long-term outcomes of surgical resection with or without adjuvant therapy for treatment of primary spinal peripheral primitive neuroectodermal tumors. Clin Neurol Neurosurg 2018; 175:25-33. [PMID: 30312956 DOI: 10.1016/j.clineuro.2018.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/18/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to assess the use of surgical treatment, the effect of postoperative adjuvant therapy, and the prognostic factors for survival of patients with primary spinal peripheral primitive neuroectodermal tumors (pPNETs). PATIENTS AND METHODS The clinical data of 24 patients, who had been surgically treated from April 2003 to February 2018 and in whom immunohistochemical staining results had confirmed the diagnosis of primary spinal pPNETs, were retrospectively analyzed. To analyze the factors related to prognosis, the Kaplan-Meier method was used for univariate analysis, the log-rank method was used to test the significance of difference, and multivariate analysis was performed using Cox regression. RESULTS The overall 1-year, 2-year, and 5-year survival rates were 73.2%, 48.1%, and 12.0%, respectively. The median survival time (MST) of all patients was 21 months. Univariate analysis showed that the extent of tumor resection, adjuvant radiotherapy, and chemotherapy were the factors influencing patient prognosis after surgery (all P < 0.05); sex, age, tumor location, and preoperative Karnofsky performance scale (KPS) scores were not the influential factors for prognosis of patients after surgery (all P > 0.05). Multivariate analysis showed that gross total resection (GTR) of tumors and adjuvant radiotherapy were independent factors influencing the prognosis of patients with pPNETs (all P < 0.05). CONCLUSIONS Primary spinal pPNETs are extremely rare, and they have a poor prognosis. Microsurgical GTR of the tumor is the preferred method of treatment. Radiotherapy plays an important role in improving the prognosis of patients with pPNETs. GTR combined with radiotherapy and chemotherapy may be the best treatment modality.
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Affiliation(s)
- Jun Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Feng Zheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Si-Cheng Tang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Qing Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juan Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Munjal S, Srivastava A, Tucker S, Bakshi N, Bhalla S, Mehta VS. Primary dorsal spine primitive neuroectodermal tumor in an adult patient: Case report and literature review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 8:378-381. [PMID: 29403254 PMCID: PMC5763599 DOI: 10.4103/jcvjs.jcvjs_70_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumor (psPNET) is a rare entity with few cases reported in literature. We report a case of a 50-year-old female who presented to us with paraplegia and was diagnosed with extradural dorsal spine psPNET. The diagnosis was not suspected at presentation or on radiology but was established on histopathological examination. It is important to distinguish it from central nervous system primitive neuroectodermal tumors and from other spinal tumors since it follows a different clinical course and therapeutic outcome.
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Affiliation(s)
| | - Amit Srivastava
- Department of Neurosurgery, Paras Hospital, Gurgaon, Haryana, India
| | - Shivya Tucker
- Department of Radiology, Moolchand Medcity, New Delhi, India
| | - Neha Bakshi
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunita Bhalla
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - V S Mehta
- Department of Neurosurgery, Paras Hospital, Gurgaon, Haryana, India
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Abstract
RATIONALE Primary spinal primitive neuroectodermal tumors (PNETs) are highly malignant tumors, which are extremely rare entities and primary intramedullary PNETs are extremely rare. Till now, only 24 cases of primary intramedullary PNET have been reported. PATIENT CONCERNS A 26-year-old male presented with progressive low back and lower limb pain for 1 month. DIAGNOSES Based on MRI and histopathological findings, he was diagnosed with primary intramedullary PNET. INTERVENTIONS The patient was treated two times with microsurgical resections. OUTCOMES Follow-up visit at 14 months after the first surgery showed that the patient is neurologically intact and free of disease. LESSONS PNETs should be considered in the differential diagnosis of an intramedullary spinal cord tumor manifesting as progressive neurological deterioration.
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Affiliation(s)
| | - Fuyou Guo
- Department of Neurosurgery
- Department of Neurosurgery, Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, ZhengZhou, HeNan Province, PR China
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Zhuang Y, Cai G, Fu C, Zhang W, Zhao W, Wang R, Wang C, Shi S, Chen C. Novel combination of paraspinal keyhole surgery with a tubular retractor system leads to significant improvements in lumbar intraspinal extramedullary schwannomas. Oncol Lett 2017; 14:7873-7879. [PMID: 29344232 PMCID: PMC5755262 DOI: 10.3892/ol.2017.7203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/02/2017] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to investigate the efficacy of combining paraspinal keyhole surgery with a tubular retractor system for the microsurgical removal of lumbar intraspinal extramedullary schwannomas. A retrospective analysis was conducted of 56 patients with lumbar intraspinal extramedullary schwannomas who were treated using the microsurgical paraspinal keyhole approach with a tubular retractor system. The mean ± standard deviation was calculated for the following parameters: Surgery time (96.21±14.64 min), hemorrhagic volume (28.54±9.72 ml), bed rest (2.55±0.5 days) and hospital stay (5.68±0.72 days). Two patients presented with cerebrospinal fluid leakage and one patient exhibited a nerve root injury. At a 6-month follow-up visit, postoperative Japanese Orthopedic Association (JOA) and visual analog scale (VAS) scores were evaluated. The mean ± standard deviation JOA scores were 12.00±2.07 for preoperative, 14.73±2.05 for 1 week postoperative, 20.07±2.32 for 3 months postoperative and 21.75±2.18 for 6 months postoperative. The improvement rate was 16.07, 47.48 and 59.77%, respectively. The mean ± standard deviation VAS scores were 6.64±1.31 for preoperative, 3.82±1.51 for 1 week postoperative, 2.11±1.17 for 3 months postoperative and 1.50±1.51 for 6 months postoperative. The JOA and VAS scores improved significantly (P<0.05). Magnetic resonance imaging and computed tomography were performed preoperatively, immediately following surgery and at the 6-month postoperative visit to confirm the efficacy of the resections and evaluate spinal stability. No residual tumors were identified at follow-up. No alterations in the stability of the spine were observed postoperatively. The combination of the microsurgical paraspinal keyhole approach with the tubular retractor system was successful in treating lumbar intraspinal extramedullary schwannomas. The surgical approach was associated with decreased hemorrhages, decreased duration of hospital stay, faster recovery and improved postoperative maintenance of spinal stability.
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Affiliation(s)
- Yuandong Zhuang
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Gangfeng Cai
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Chaofeng Fu
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Weiqiang Zhang
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Wei Zhao
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Rui Wang
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Chunhua Wang
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Songsheng Shi
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
| | - Chunmei Chen
- Department of Neurosurgery, Union Hospital of Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou, Fujian 350001, P.R. China
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Khmou M, Malihy A, Lamalmi N, Rouas L, Alhamany Z. Peripheral primitive neuroectodermal tumors of the spine: a case report and review of the literature. BMC Res Notes 2016; 9:438. [PMID: 27613377 PMCID: PMC5016941 DOI: 10.1186/s13104-016-2246-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background Peripheral primitive neuroectodermal tumors are extremely rare tumors in the spine; only 18 cases of extra-dural peripheral primitive neuroectodermal tumor cervical region have been reported. The aim of this report is to highlight the challenges in diagnosis and management of this condition. Case presentation We present a case of 5-year-old Moroccan boy, who presented with torticollis for 1 month. Computed tomography scan and Magnetic resonance imaging of the cervical spine revealed an extradural, dumbbell-shaped mass with extra-spinal extension at the left C1–C6 level. Multiple biopsy specimens were obtained. Histological examination revealed a highly cellular neoplasm composed of diffuse sheets of tumor cells having monomorphic, round to oval, finely vesicular nuclei. Immunohistochemical findings confirmed the diagnosis of intraspinal peripheral primitive neuroectodermal tumor. Conclusion After this illustrative case, we review the literature on clinicopathological and therapeutic aspects. In practice, it is important to consider the diagnosis of peripheral primitive neuroectodermal tumor in children and adolescents with an apparent soft-tissue mass located in the spine.
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Affiliation(s)
- Mouna Khmou
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco. .,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco.
| | - Abderrahmane Malihy
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Najat Lamalmi
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Lamia Rouas
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Zaitouna Alhamany
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
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