Primary Ewing's Sarcoma of the Spine

Abstract

Primary Ewing's sarcoma of the spine is sufficiently rare to justify the reporting of an additional case. The roentgenographic changes in that location obviously are not those typical of similar involvement of the long bones. A survey of the pertinent literature reveals 10 cases of primary Ewing's sarcoma of the spine. In a review of the material in the Bone Sarcoma Registry (1927) and a comprehensive discussion of sarcoma of the bone, Kolodny (1) states that Ewing's sarcoma constitutes 7.5 per cent of bone sarcomas. In his opinion, a Ewing's sarcoma usually affects more than one vertebra, but he believes that this represents multiple primary involvement and not metastatic growth. He reports a series of 650 cases of bone tumor with 40 instances of Ewing's sarcoma and 10 others of more or less doubtful nature. The spine is mentioned as being a favorite site of the tumor, but the incidence of such involvement is not given. Rix and Geschickter (2) report a series of 291 tumors of the spine, of which 21 were primary malignant neoplasms. They report no cases of Ewing's sarcoma but list 12 cases of sympathicoblastoma and discuss the possibility of it being confused with a Ewing's sarcoma. Geschickter and Copeland (3) report a series of 125 cases of Ewing's sarcoma and list one instance of primary involvement of the vertebra. Geschickter and Maseritz (4) discuss the clinical and microscopic similarity of neuroblastoma and Ewing's sarcoma and report a series of 135 cases of the latter tumor. No mention of primary involvement of the spine is made. Stewart Harrison (5) reports 8 cases of Ewing's bone sarcoma, none of which was primary in the spine. Lattman (6) published a review on Ewing's sarcoma but did not mention primary occurrence in the spine. He states that primary malignant disease of the bone is rare (1.5 to 2.0 per cent of all malignant neoplasms), with Ewing's sarcoma accounting for approximately 10 per cent of the bone sarcomas. Brav and Rechtman (7) reported a single case of a Ewing's sarcoma primary in the sacrum, with autopsy findings. Neely and Rogers (8) report two cases of primary bone neoplasm of the spine with a histopathological picture consistent with Ewing's sarcoma. These two cases showed no cell type compatible with a diagnosis of sympathicoblastoma. In a more recent study, Morton (9) reports 6 cases of Ewing's sarcoma of the spine as listed in the Bone Sarcoma Registry (covering the period up to the fall of 1936). A total of 184 cases of Ewing's sarcoma of bone were listed in the Registry for the same period. Case Report Clinical History: A white male, aged 21 years, was admitted to the Letterman General Hospital, March 21, 1944, for deep x-ray therapy to the 12th dorsal vertebra and the right 12th rib. The family history was irrelevant and the developmental history was normal. The patient had been well until September 1943, when he experienced a sudden sharp pain in his right hip.