Extraskeletal Ewing's Sarcoma With Vertebral Metastasis: A Case Report

Abstract

Ewing's sarcoma (ES) is the second most common osseous tumor in young patients after osteosarcoma. All primitive neuroectodermal tumors (PNET) and Askin tumors are members of Ewing's sarcoma family of tumors (ESFT), which all have aberrant translocations between the 11th and 22nd chromosomes. Only one in five cases of Ewing's sarcoma occurs as extraskeletal. In this report, we describe a young female with a palpable lump on her spine who presented with paravertebral and thoracic extraskeletal Ewing's sarcoma (EES). Over six months, the swelling gradually increased in size, and the patient reported episodes of episodic pain and fever. Examining the swelling, a non-reducible, non-tender ovoid lump measuring approximately 8 cm x 5 cm was found to have smooth margins and be slightly mobile. The use of magnetic resonance imaging (MRI) helped diagnose, plan surgical resections, assess neoadjuvant chemotherapy effectiveness, and detect local recurrences and metastatic spread of the tumor. The differential diagnosis of EES included embryonal rhabdomyosarcoma and lymphoma. The use of immunohistochemical markers further differentiated the diagnoses. In conclusion, it should be noted that EES, though rare, should be considered when evaluating soft tissue lumps of neoplastic characteristics, in children or adolescents. Considering the poor prognosis of this disease, early detection is essential. The MRI plays a vital role in diagnosing cancer, staging it locally, assessing response to neoadjuvant therapy, and identifying local recurrences and metastases.

Adult Intradural Extramedullary Ewing’s Sarcoma of the Lumbar Spine and Involving the Intervertebral Foramen: A Case Report

“…Friend leukemia integration 1 (FLI1) is highly expressed in cases of Ewing sarcoma with EWSR1-FLI1 gene fusion and has relatively higher specificity than CD99 [2,3,23]. Besides, vimentin (Vim) also diffusely expressed in these tumors [23]. The patient in our case showed positive for CD99, FLI1, Vim, indicating a favored diagnosis of EES.…”

“…A spectrum of immunohistochemical markers is used to study EES [3]. Diffuse membranous expression of CD99 is characteristic for Ewing sarcoma (~95%) [2,5,23,24]. CD99 lacks specificity, however, as it also expressed in other primitive neuroectodermal tumors [23].…”

“…Diffuse membranous expression of CD99 is characteristic for Ewing sarcoma (~95%) [2,5,23,24]. CD99 lacks specificity, however, as it also expressed in other primitive neuroectodermal tumors [23]. Friend leukemia integration 1 (FLI1) is highly expressed in cases of Ewing sarcoma with EWSR1-FLI1 gene fusion and has relatively higher specificity than CD99 [2,3,23].…”

“…CD99 lacks specificity, however, as it also expressed in other primitive neuroectodermal tumors [23]. Friend leukemia integration 1 (FLI1) is highly expressed in cases of Ewing sarcoma with EWSR1-FLI1 gene fusion and has relatively higher specificity than CD99 [2,3,23]. Besides, vimentin (Vim) also diffusely expressed in these tumors [23].…”

Unusual Presentation of Thoracic Epidural Ewing Sarcoma in a 20-Year-Old Patient: A Case Report

“…In our clinical case, CD99 examination revealed over 60% membrane positivity, supporting the diagnosis of Ewing's sarcoma. Additional studies supporting the diagnosis are the t(11;22)(q24;q12) and t(21:22) (q22:q12) translocations detected by molecular genetics [1,[7][8][9][10]. In our case, the indicated genes were not examined due to the lack of the necessary equipment.…”