A 30-year-old patient with a C8 nerve root lesion: question

Abstract

•A very uncommon case of cervical nerve root Ewing sarcoma was presented.•The preoperative diagnosis of such lesion is challenging.•The correct diagnosis of Ewing sarcoma is essential to plan an effective chemoradiotherapy. A 30-year-old woman presented with a 3-week history of pain and hypoesthesia of the ulnar side fingers of the left hand. The symptoms spread to the ipsilateral whole arm and shoulder, associated with weakness of the triceps brachialis. Neurological examination revealed also reduction of triceps and biceps brachialis reflexes. Magnetic resonance imaging (MRI) showed a 5 × 7 × 9 mm low-enhancement lesion, localized at the left C8 nerve root (Fig. 1A, B). The patient underwent hemi-laminectomy with total removal of the lesion. a.Schwannomab.Non-Hodgkin’s lymphomac.Solitary fibrous tumord.Ewing sarcomae.Neurofibroma Answer on page: 240. Patient details and images have been anonymised. No conflict of interests by any of the authors. A 30-year-old patient with a C8 nerve root lesion: AnswerJournal of Clinical NeuroscienceVol. 77PreviewHistological examination showed nerve root fascicles infiltrated by a small round cell tumor (Fig. 2A) positive for vimentin, synaptophysin, CD99 and FL1, and negative for S-100, AE1/AE3, CD45 and CD56. Ki-67 labeling index reached 15%. FISH analysis revealed EWSR1 rearrangement (Fig. 2B), confirming the diagnosis of Ewing sarcoma. Postoperative course was uneventful, characterized by decrease of the pain and improvement of the neurological symptoms. A total-body CT and PET scans were negative, suggesting a primitive origin of the tumor from the C8 nerve root. Full-Text PDF