Primary Ewing's Sarcoma of Spine Mimicking Nerve Sheath Tumor

Abstract

Introduction A 32-year-old man admitted to our clinic after 1 month history of progressively worsening back pain. He had no previous pain or systemic symptoms before this history. Neurological examination revealed paraparesis at lower extremity. Sensibility was decreased below the level Th 12. Bladder dysfunction was admitted. Laboratory assessments including erythrocyte sedimentation rate are normal limits. Magnetic resonance imaging demonstrated an epidural mass at the T5-7. Lesion invading chest and soft tissues. Sagittal projection of T2 MRI image demonstrating tumor 7 × 5 × 4 cm size, displacing the spinal cord to the left side and invasion of mediastinum (Fig. 1). PET CT shows increased activity in T5-6 level. The patient underwent surgery as the first line of management. The tumor was removed mostly by the combined anterior and posterior approach. Anterior reconstruction was carried out using a titanium cage. Materials and Methods Histopathological examinations confirmed an Ewing's sarcoma arising from the thoracic epidural space. After 1 week of surgery, the patient was referred to the oncology department. He underwent a combined radiotherapy and chemotherapy protocol. Results Occurrence of primary Ewing's sarcoma of the spine has been rarely reported in the literature. It occurs from 12 to 24 years of age and is very rare after 30 years. Local back pain usually is the first and typical complaint occur like a schwannoma. MRI of the thoracal spine revealed lesion at the right neural foramen appearing to originate from the nerve root and invading mediastinum, suspicious for a giant spinal schwannomas. Conclusion In ES cases, vertebrae are affected in less than 5%. Unlike schwannomas, the ES prognosis is usually poor. After surgery, radiation therapy, and chemotherapy the mean survival time was 2.9 years. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared