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Krouma M, Farah K, Choucha A, Appay R, Duffaud F, Fuentes S, Dufour H. Primary intradural Extraosseous Ewing's sarcoma of the cauda equina: A case report and literature review. Neurochirurgie 2024; 70:101562. [PMID: 38621473 DOI: 10.1016/j.neuchi.2024.101562] [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: 11/06/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
Intradural Extraosseous Ewing sarcoma (IEES) is an infrequent occurrence. We report a case of a 66-year-old male who presented with a 2-month history of low back pain and bilateral S1 sciatica, with acute sphincter dysfunction. Imaging studies revealed an intradural extramedullary lesion in the cauda equina spanning from level L4 to S1. The patient underwent partial removal of the intradural lesion. Histopathological examination showed the presence of small round cells, which were consistent with Ewing Sarcoma. The patient was then treated with targeted radiation therapy and chemotherapy. The rarity of IEES in this specific location underscores the significance of evaluating and managing patients with intradural spinal tumors with careful consideration of this diagnosis. To further investigate this condition, we conducted a thorough review of the literature on IEES involving the lumbar spine and cauda equina. Our analysis revealed that patients with this condition frequently exhibit rapidly progressive neurological symptoms likely attributed to hemorrhagic transformation. This characteristic may serve as a distinguishing factor from other lesion types, particularly benign ones. Our study provides a comprehensive summary that can offer direction for clinical management in comparable uncommon and novel cases.
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Affiliation(s)
- Manel Krouma
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France.
| | - Kaissar Farah
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Anis Choucha
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Romain Appay
- Department of Pathology, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Florence Duffaud
- Department of Oncology, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Stephane Fuentes
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
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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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Shihadeh OM, Khan MM, Salih H, Thabet A, Belkhair S. Primary Ewing Sarcoma of the Cervical Spine: A Case Report and Literature Review. Cureus 2023; 15:e42687. [PMID: 37649939 PMCID: PMC10464919 DOI: 10.7759/cureus.42687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Ewing sarcoma is a rare neoplasm that mostly grows in bones or soft tissues around bones. Most cases of Ewing sarcoma occur in intra-skeletal locations (long bones, pelvis, or ribs) and rarely in extra-skeletal regions such as paravertebral or epidural space, whereas a primary intradural extramedullary Ewing sarcoma (IEES) is extremely rare. Fifty cases of primary IEES including our case were identified in the literature, so far, of which two-thirds are in the lumbosacral region, while only 12 reports described a cervical location of the tumor. Herein, we are presenting a case of C7-T1 primary IEES for a 24-year-old male, followed by a review of updated literature about the primary IEES in the cervical spine.
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Affiliation(s)
| | | | - Hayel Salih
- Neurosurgery, Hamad Medical Corporation, Doha, QAT
| | | | - Sirajeddin Belkhair
- Neurosurgery, Weill Cornell Medicine-Qatar, Doha, QAT
- Neurosurgery, Hamad Medical Corporation, Doha, QAT
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Carballo Cuello CM, De Jesus O, de Jesús Espinosa A, Fernández-de Thomas RJ, Murray G, Pastrana EA. Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review. Cureus 2022; 14:e26665. [PMID: 35959190 PMCID: PMC9360665 DOI: 10.7759/cureus.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/08/2023] Open
Abstract
Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.
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Kamal AF, Cahayadi SD, Shihab RA, Ramang DS. A challenging diagnosis: Lesson from case series of sacral Ewing sarcoma. Int J Surg Case Rep 2022; 94:107073. [PMID: 35658276 PMCID: PMC9171444 DOI: 10.1016/j.ijscr.2022.107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Ewing's sarcoma is an aggressive bone and the surrounding soft tissue cancer primarily found in children and young adults. It is mostly observed in the trunk and long bones while unusually seen in the sacrum. Sacral Ewing sarcoma has a unique anatomic limitation due to neurological structures, vertebral column, and pelvic involvement. Hence, identifying sacral Ewing's sarcoma remains a challenge. Method This is a case series including three patients diagnosed with Sacral Ewing's sarcoma. These three cases have been diagnosed based on clinical and radiographic examination, MRI, histopathology, and immunohistochemistry examination. Discussion Sacral Ewing's sarcoma remains a challenge to diagnose due to its unique anatomy site. MRI examination is sensitive to detect lesions but nonspecific. Thus, require histopathological confirmation. Conclusion Early diagnosis of Ewing's sarcoma is essential and we need to perform further examinations, such as immunohistochemistry examination, to confirm the diagnosis of Ewing's sarcoma. Sacral Ewing's sarcoma remains a challenge to diagnose due to its unique anatomy site. MRI examination is sensitive to detect lesions but nonspecific. We recommended to perform further examinations, such as immunohistochemistry examination, to confirm the diagnosis of Ewing’s sarcoma.
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Huguenard AL, Li YD, Sharifai N, Perkins SM, Dahiya S, Chicoine MR. Multifocal primary central nervous system Ewing sarcoma presenting with intracranial hemorrhage and leptomeningeal dissemination: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2042. [PMID: 35855436 PMCID: PMC9241201 DOI: 10.3171/case2042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Ewing sarcoma is a neoplasm within the family of small round blue cell tumors and most frequently arises from skeletal bone. Primary involvement of the central nervous system in these lesions is extremely rare, with an incidence of 1%. OBSERVATIONS A case is presented of a 34-year-old man who presented with left facial numbness, multiple intracranial lesions, a lumbar intradural lesion, and diffuse spinal leptomeningeal involvement. A lumbar laminectomy and biopsy were performed, which revealed the diagnosis of extraskeletal Ewing sarcoma/primitive neuroectodermal tumor. The patient had a rapidly progressive clinical decline despite total neuroaxis radiation and multiple lines of chemotherapeutic treatments, eventually dying from his disease and its sequelae 6 months after diagnosis. LESSONS The authors' review of 40 cases in the literature revealed only 2 patients with isolated intraaxial cranial lesions, 4 patients with cranial and spine involvement, and an additional 34 patients with spine lesions. The unique characteristics of this patient's case, including his presentation with diffuse disease and pathology that included a rare V600E BRAF mutation, are discussed in the context of the available literature.
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Sharma A, Sethi N, Saini S, Pandia K, Jangir R. Primary Ewings sarcoma in liver - A rare case report with review of literature. INDIAN J PATHOL MICR 2021; 64:S136-S139. [PMID: 34135155 DOI: 10.4103/ijpm.ijpm_288_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Ewing's sarcoma family of tumours include both peripheral primitive neuroectodermal tumour (PNET) and Ewing's sarcoma including both intraosseous and extra osseous sites. Rarest of all is the involvement of liver as primary site, of which only 4 case reports have been published. We report a very rare case of 4 year old male child with primary Ewing's Sarcoma in the liver along with review of literature. The child presented with pain abdomen and low grade fever and hepatomegaly. On putting extensive IHC panel on liver SOL biopsy the small round cells were positive for FLI-1 & CD99 & were immunonegative for OCH, LCA, AFP, WT1, NSE, MYOGENIN, B-catenin & glypican 3. The histopathological and immunohistochemical profile was suggestive of Ewing's Sarcoma. To our knowledge, this is the fifth reported case of Ewing's Sarcoma occurring in liver as primary & first case to be present in a young boy of 4 years age.
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Affiliation(s)
- Anjali Sharma
- Department of Pathology, BMCHRC, Jaipur, Rajasthan, India
| | - Neha Sethi
- Department of Pathology, BMCHRC, Jaipur, Rajasthan, India
| | - Shashikant Saini
- Department of Surgical Oncology, BMCHRC, Jaipur, Rajasthan, India
| | - Kirti Pandia
- Department of Pathology, BMCHRC, Jaipur, Rajasthan, India
| | - Ritu Jangir
- Department of Pathology, BMCHRC, Jaipur, Rajasthan, India
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Izubuchi Y, Nakajima H, Honjoh K, Imamura Y, Nojima T, Matsumine A. Primary intradural extramedullary Ewing sarcoma: A case report and literature review. Oncol Lett 2020; 20:2347-2355. [PMID: 32782552 PMCID: PMC7401003 DOI: 10.3892/ol.2020.11786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Tumors of the spinal cord and cauda equina show a wide spectrum of histology and require careful diagnosis and treatment. Primary intradural extramedullary Ewing sarcoma (IEES) is extremely rare, and initial imaging and clinical findings for this tumor mimic those of benign intradural spinal tumors. The present report describes a case of a 35-year-old woman who presented with IEES with meningeal seeding, and the literature on the management and clinical course of these tumors was reviewed. An examination revealed right-side leg dominant rapidly progressive hypoesthesia and motor deficits. MRI identified intradural tumors at the T12-L1 and L4-5 levels. Growth and an increase in the number of intradural tumors occurred over 3 weeks. Gadolinium-contrast T1-weighted MRI revealed diffusely enhanced signals for tumorous lesions with meningeal seeding in the cervical and thoracic spinal cord. Excision of a tumor at T12-L1 was performed to alleviate the symptoms and to make a histologic diagnosis. Microscopically, the tumor consisted of dense sheets of small round cells. Immunohistochemically, tumor cells showed intense and diffuse positive staining for CD99, ETS transcription factor ERG and Fli-1 proto-oncogene, ETS transcription factor (FLI1). The sequence analysis revealed the EWS RNA binding protein 1-FLI1 fusion transcript. The lesion was diagnosed as primary intradural ES. Adjuvant chemotherapy following radiotherapy for the whole spine was performed; however, multiple brain metastases were found at 10 months after diagnosis and the patient died of diffusely disseminated disease limited to the central nervous system without evidence of distant metastases at 16 months after the initial diagnosis. In a literature review of IEES cases, the 1- and 5-year overall survival rates were 79.8 and 26.6%, respectively, and the 1-, 2- and 5-year progression-free survival rates were 61.0, 52.3 and 10.9%, respectively. Therefore, primary IEES has a poor prognosis compared with ES of bone, and novel agents and treatment strategies are required.
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Affiliation(s)
- Yuya Izubuchi
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui 910-1193, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui 910-1193, Japan
| | - Kazuya Honjoh
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui 910-1193, Japan
| | - Yoshiaki Imamura
- Division of Diagnostic Pathology/Surgical Pathology, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
| | - Takayuki Nojima
- Department of Pathology, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Akihiko Matsumine
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui 910-1193, Japan
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Tan CH, Tan D, Phung TB, Lai LT. Primary intradural extramedullary Ewing sarcoma of the cervical spine: A case report and review of the literature. J Clin Neurosci 2019; 66:280-284. [PMID: 31113698 DOI: 10.1016/j.jocn.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/19/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
Spinal intradural Ewing sarcoma (ES) of the cervical region is not common. Few cases have been reported and optimal management remain poorly defined. We described a case of a young woman with extensive primary leptomeningeal spinal ES and conducted a review of the literature.
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Affiliation(s)
- Chi Hau Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Darius Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Teik Beng Phung
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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Lu VM, Goyal A, Alvi MA, Kerezoudis P, Haddock MG, Bydon M. Primary intradural Ewing’s sarcoma of the spine: a systematic review of the literature. Clin Neurol Neurosurg 2019; 177:12-19. [DOI: 10.1016/j.clineuro.2018.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
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