Imaging findings of the spinal peripheral Ewing's sarcoma family of tumours

Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.

Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.

Sacral Tumours on MRI: A Pictorial Essay

Tumours of the sacrum can be primary or secondary. Since the sacrum is rich in haematopoietic bone marrow, bone metastases are the most frequent aetiologies. However, tumours can arise from all components of the sacrum and primary bone tumours should be considered in case of a solitary lesion and absence of oncologic history. As the clinical signs are usually non-specific, magnetic resonance imaging has become an indispensable tool in narrowing the differential diagnosis and determining the therapeutic approach. This pictorial essay illustrates specific features of the most common sacral tumours on magnetic resonance (MR) imaging.

Revision Surgical Treatment of a Second Lumbar Ewing Sarcoma: A Report of a Rare Case

We report a case of a 58-year-old man who presented initially with lumbar pain.According to radiography, computed tomography, magnetic resonance imaging, and bone biopsy results, Ewing sarcoma (ES) was diagnosed. Tumor resection was performed, followed by chemotherapy and radiotherapy; pathology confirmed the diagnosis of ES. After surgery, the tumor recurred twice with progressive symptoms, meriting repeated excisional surgery. At the 4-year follow-up, the patient showed apparent improvement, with return of function and strength and resolution of pain.We discuss its clinical features and treatment in the light of the current knowledge.

The imaging features of meningeal Ewing sarcoma/peripheral primitive neuroectodermal tumours (pPNETs)

OBJECTIVE

To explore the imaging features of meningeal Ewing sarcoma/peripheral primitive neuroectodermal tumours (pPNETs).

METHODS

The imaging features and pathological characteristics of eight cases of surgically and pathologically confirmed Ewing sarcoma/pPNET were analysed retrospectively in light of recent literature on the disease.

RESULTS

The peak age was between 10 and 20 years. The lesions tended to be spindle shaped and dural based, usually widely so. CT showed that the lesions had slightly uneven high density in five cases and iso-low mixed density in three cases; marked heterogeneous enhancement was seen in all cases after contrast injection. MRI of the lesions showed varying proportions of isointense and hypointense signal in all cases on unenhanced T1 weighted imaging and varying proportions of isointense and hyperintense signal on T2 weighted imaging. After contrast injection, marked heterogeneous enhancement was seen in all cases; three cases showed a short and nodular dural tail and five cases showed adjacent skull erosion and osteolysis. Pathological results included high cell density, haemorrhage and necrosis. The cells resembled lymphocytes and spindle cells with transparent cytoplasm. CD99 and vimentin were expressed by all tumour cells.

CONCLUSION

Features of meningeal Ewing sarcoma/pPNETs include peak incidence at 10-20 years of age, a broad connection to the meninges, a thick dural tail involved with tumour, skull and scalp erosion and early metastasis. Necrosis and cystic changes are the common histological findings.

ADVANCES IN KNOWLEDGE

The imaging features of meningeal Ewing sarcoma/pPNETs have not been reported. The study helps to identify meningeal Ewing sarcoma/pPNETs and meningioma.