Limits...
A Unique Case of Primary Ewing's Sarcoma of the Cervical Spine in a 53-Year-Old Male: A Case Report and Review of the Literature.

Holland MT, Flouty OE, Close LN, Reddy CG, Howard MA - Case Rep Med (2015)

Bottom Line: In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness.Imaging revealed a cervical spinal canal mass.A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age (age = 38).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52246, USA.

ABSTRACT
Extraskeletal Ewing's sarcoma (EES) is a rare presentation, representing only 15% of all primary Ewing's sarcoma cases. Even more uncommon is EES presenting as a primary focus in the spinal canal. These rapidly growing tumors often present with focal neurological symptoms of myelopathy or radiculopathy. There are no classic characteristic imaging findings and thus the physician must keep a high index of clinical suspicion. Diagnosis can only be definitively made by histopathological studies. In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness. Imaging revealed a cervical spinal canal mass. After undergoing cervical decompression, histopathological examination confirmed a diagnosis of Ewing's sarcoma. A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age (age = 38). Given the low incidence of this pathology presenting in this age group and the lack of treatment guidelines, each patient's plan should be considered on a case-by-case basis until further studies are performed to determine optimal evidence based treatment.

No MeSH data available.


Related in: MedlinePlus

Cervical MRI: (a) midsagittal T2 MRI (TR = 4000, TE = 98) and (b) midsagittal T1 postcontrast (TR = 659, TE = 8.7) imaging of the cervical spine showing a C2–C7 ill-defined extradural mass that is hypointense on T2 and enhances with contrast most predominant at C6-C7. ((c) and (d)) Two axial slices of a preoperative T1 postgadolinium contrast (TR = 591, TE = 7.3) MRI of the cervical spine passing through the C6-C7 level demonstrates an extradural, enhancing mass invading the spinal canal eccentric to the left.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4352905&req=5

fig1: Cervical MRI: (a) midsagittal T2 MRI (TR = 4000, TE = 98) and (b) midsagittal T1 postcontrast (TR = 659, TE = 8.7) imaging of the cervical spine showing a C2–C7 ill-defined extradural mass that is hypointense on T2 and enhances with contrast most predominant at C6-C7. ((c) and (d)) Two axial slices of a preoperative T1 postgadolinium contrast (TR = 591, TE = 7.3) MRI of the cervical spine passing through the C6-C7 level demonstrates an extradural, enhancing mass invading the spinal canal eccentric to the left.

Mentions: On examination, the patient appeared emaciated and easily fatigable. Muscle strength testing revealed 2/5 in the left upper extremity with exception of the biceps at 3/5 and handgrip of 4-/5. His right upper extremity was 3/5 in the deltoid and 4-/5 in all other muscle groups. The bilateral lower extremities were 5/5 for strength. There were no myelopathic signs. A repeat MRI performed at our institution showed an ill-defined predominantly extradural enhancement along the left aspect of the cervical spinal canal, most apparent at C6-C7, but also extending between C2 and C7 (Figure 1). A CT chest/abdomen/pelvis showed no evidence of other primary diseases. After being admitted to the hospital, the patient acutely developed increased difficulty with his gait and experienced an episode of urinary incontinence.


A Unique Case of Primary Ewing's Sarcoma of the Cervical Spine in a 53-Year-Old Male: A Case Report and Review of the Literature.

Holland MT, Flouty OE, Close LN, Reddy CG, Howard MA - Case Rep Med (2015)

Cervical MRI: (a) midsagittal T2 MRI (TR = 4000, TE = 98) and (b) midsagittal T1 postcontrast (TR = 659, TE = 8.7) imaging of the cervical spine showing a C2–C7 ill-defined extradural mass that is hypointense on T2 and enhances with contrast most predominant at C6-C7. ((c) and (d)) Two axial slices of a preoperative T1 postgadolinium contrast (TR = 591, TE = 7.3) MRI of the cervical spine passing through the C6-C7 level demonstrates an extradural, enhancing mass invading the spinal canal eccentric to the left.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352905&req=5

fig1: Cervical MRI: (a) midsagittal T2 MRI (TR = 4000, TE = 98) and (b) midsagittal T1 postcontrast (TR = 659, TE = 8.7) imaging of the cervical spine showing a C2–C7 ill-defined extradural mass that is hypointense on T2 and enhances with contrast most predominant at C6-C7. ((c) and (d)) Two axial slices of a preoperative T1 postgadolinium contrast (TR = 591, TE = 7.3) MRI of the cervical spine passing through the C6-C7 level demonstrates an extradural, enhancing mass invading the spinal canal eccentric to the left.
Mentions: On examination, the patient appeared emaciated and easily fatigable. Muscle strength testing revealed 2/5 in the left upper extremity with exception of the biceps at 3/5 and handgrip of 4-/5. His right upper extremity was 3/5 in the deltoid and 4-/5 in all other muscle groups. The bilateral lower extremities were 5/5 for strength. There were no myelopathic signs. A repeat MRI performed at our institution showed an ill-defined predominantly extradural enhancement along the left aspect of the cervical spinal canal, most apparent at C6-C7, but also extending between C2 and C7 (Figure 1). A CT chest/abdomen/pelvis showed no evidence of other primary diseases. After being admitted to the hospital, the patient acutely developed increased difficulty with his gait and experienced an episode of urinary incontinence.

Bottom Line: In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness.Imaging revealed a cervical spinal canal mass.A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age (age = 38).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52246, USA.

ABSTRACT
Extraskeletal Ewing's sarcoma (EES) is a rare presentation, representing only 15% of all primary Ewing's sarcoma cases. Even more uncommon is EES presenting as a primary focus in the spinal canal. These rapidly growing tumors often present with focal neurological symptoms of myelopathy or radiculopathy. There are no classic characteristic imaging findings and thus the physician must keep a high index of clinical suspicion. Diagnosis can only be definitively made by histopathological studies. In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness. Imaging revealed a cervical spinal canal mass. After undergoing cervical decompression, histopathological examination confirmed a diagnosis of Ewing's sarcoma. A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age (age = 38). Given the low incidence of this pathology presenting in this age group and the lack of treatment guidelines, each patient's plan should be considered on a case-by-case basis until further studies are performed to determine optimal evidence based treatment.

No MeSH data available.


Related in: MedlinePlus