Intradural Extramedullary Ewing Sarcoma in an Adolescent Female

Abstract

A 15-year-old female experiencing lumbar pain without prior trauma. Despite being prescribed strong analgesics by her family physician, the symptoms intensified, and she was referred to diagnostic imaging. Magnetic resonance imaging revealed an intradural extramedullary tumor in the spinal canal, located behind the L3 corpora. The patient underwent neurosurgery with a complete resection of the tumor. The histopathologic examination revealed Ewing sarcoma by identifying EWSR1 gene in the extracted tissue. The patient was subsequently referred for extensive specialized oncological treatment including photon irradiation therapy and chemotherapy. Thirty-six months on from the initial diagnosis, the patient is doing well and suffers no sequelae apart from hypogonadism.

Primary intramedullary extradural Ewing sarcoma

“…Kunwald et al report the only other case of craniospinal radiation in addition to surgical resection and chemotherapy in an adolescent female. At 17 months post-treatment, they report no sequelae of disease aside from hypogonadism and no evidence of recurrent disease on imaging at 36 months [13] . In our case, despite the metastatic nature which is unlike the other cases, there is no evidence of disease recurrence at 25 months post-treatment completion.…”

“…However, IEES is exceedingly rare and consequently little evidence exists regarding appropriate treatment for this condition [10] , [11] , [12] . Existing literature in pediatric cases outline a combination of surgery, systemic chemotherapy and localized radiation as treatment [ 10 , 13 ]. Similarly in this case, the patient was treated with a combination of surgical resection, chemotherapy, and radiation therapy.…”

“…Similarly in this case, the patient was treated with a combination of surgical resection, chemotherapy, and radiation therapy. Only six case reports exist on primary IEES in the pediatric population [ 10 , 13 ]. However, our case is unique in the unusual intracranial component of the tumor, which to our knowledge, has not been previously described in a case of IEES.…”

Care-Seeking Adolescents With Low Back Pain From General Practice: Prevalent but Understudied

“…Although cancer and metastatic pain are categorised as serious pathology (4), primary cancer tumours may also lead to nerve root compression and radiculopathy in patients with no previous history of cancer (10).…”