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Spinal intradural metastasis from scapular Ewing sarcoma.

Ralapanawa DM, Jayawickreme KP, Ekanayake EM, Kumarihamy KW - BMC Res Notes (2015)

Bottom Line: It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians.For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.Intradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.

ABSTRACT

Background: Ewing sarcoma is a primary bone neoplasm, which is a high grade aggressive small round blue cell tumour, and is currently recognized as a part of the Ewing family of tumours. It is the most lethal bone tumor, and is a rare malignant bone tumor accounting for 10% of all primary bone tumors, and 6% of malignant bone tumors. It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians. It commonly occurs in long bones and pelvis but rarely involves the scapula. 85% of cases have metastasis within 2 years of diagnosis, rarely involving the meninges.

Case presentation: We report a case of a 25 year old Sinhalese Sri Lankan female, presenting with a 1 day history of bilateral lower limb weakness and urinary incontinence. She had a sensory level with flaccid paralysis of lower limbs and a painless bony lump in the left dorsal scapula. Investigations showed scapular primary Ewing sarcoma giving rise to spinal intradural metastasis. For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.

Conclusion: Intradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.

No MeSH data available.


Related in: MedlinePlus

Radiograph of the left scapula. Radiograph of the left scapula showing a bony mass with multiple lytic lesions in the lateral and dorsal aspects.
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Fig1: Radiograph of the left scapula. Radiograph of the left scapula showing a bony mass with multiple lytic lesions in the lateral and dorsal aspects.

Mentions: She was investigated with a suspicion of metastatic disease and X-ray of the left shoulder showed a soft tissue and bony mass on the dorsal aspect of the left scapula with multiple lytic lesions suggestive of a primary bone neoplasm (Figure 1), but chest radiograph, ultrasound scan of the neck, and Computed tomography (CT) of abdomen were normal. Magnetic resonance imaging (MRI) of the spine showed an intradural extramedullary mass with an extra spinal component at C7-T2 level causing severe cord compression (Figure 2), hence intravenous dexamethasone regimen was started.Figure 1


Spinal intradural metastasis from scapular Ewing sarcoma.

Ralapanawa DM, Jayawickreme KP, Ekanayake EM, Kumarihamy KW - BMC Res Notes (2015)

Radiograph of the left scapula. Radiograph of the left scapula showing a bony mass with multiple lytic lesions in the lateral and dorsal aspects.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4495625&req=5

Fig1: Radiograph of the left scapula. Radiograph of the left scapula showing a bony mass with multiple lytic lesions in the lateral and dorsal aspects.
Mentions: She was investigated with a suspicion of metastatic disease and X-ray of the left shoulder showed a soft tissue and bony mass on the dorsal aspect of the left scapula with multiple lytic lesions suggestive of a primary bone neoplasm (Figure 1), but chest radiograph, ultrasound scan of the neck, and Computed tomography (CT) of abdomen were normal. Magnetic resonance imaging (MRI) of the spine showed an intradural extramedullary mass with an extra spinal component at C7-T2 level causing severe cord compression (Figure 2), hence intravenous dexamethasone regimen was started.Figure 1

Bottom Line: It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians.For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.Intradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.

ABSTRACT

Background: Ewing sarcoma is a primary bone neoplasm, which is a high grade aggressive small round blue cell tumour, and is currently recognized as a part of the Ewing family of tumours. It is the most lethal bone tumor, and is a rare malignant bone tumor accounting for 10% of all primary bone tumors, and 6% of malignant bone tumors. It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians. It commonly occurs in long bones and pelvis but rarely involves the scapula. 85% of cases have metastasis within 2 years of diagnosis, rarely involving the meninges.

Case presentation: We report a case of a 25 year old Sinhalese Sri Lankan female, presenting with a 1 day history of bilateral lower limb weakness and urinary incontinence. She had a sensory level with flaccid paralysis of lower limbs and a painless bony lump in the left dorsal scapula. Investigations showed scapular primary Ewing sarcoma giving rise to spinal intradural metastasis. For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.

Conclusion: Intradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.

No MeSH data available.


Related in: MedlinePlus