Abstract
Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma-like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression-free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.
Highlights
The incidence of Ewing’s sarcoma of bone (ESB) is 1.7 to 2.1 per million people in the United States.[1]
Unlike in extremities, Ewing sarcoma in the spinal epidural space or the spinal column cannot be resected with wide margins due to relevant structures such as major vessels, oesophagus, and the myelon
It is thought that prognosis of Ewing sarcoma is mainly dependent on the presence of metastases at initial diagnosis and not by tumour site, volume or local therapy modality.[9]
Summary
The incidence of Ewing’s sarcoma of bone (ESB) is 1.7 to 2.1 per million people in the United States (about 200 new cases/year).[1]. Prognosis is still dismal (3- to 4-fold reduced survival), if distant metastasis occurs.[8] In general Ewing tumours are radio- and chemosensitive. These modalities play a major role in a multimodal therapy concept. The interdisciplinary tumour-board decided to administer a salvage chemotherapy (topotecan and cyclophosphamide, two cycles) combined with radiotherapy (local boost and the whole spinal canal, 36 Gy). Afterwards he received highdose busulfan and mephalan and autologous stem cell transplantation. The patient had no worsening of his neurological symptoms and is free of local and distant recurrence (Figures 1-3)
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