Primary Ewing Sarcoma of the Spine Mimicking a Psoas Abscess Secondary to Spinal Infection

Akeda, Koji; Kasai, Yuichi; Kawakita, Eiji; Seto, Masashi; Kono, Takako; Uchida, Atsushi

doi:10.1097/brs.0b013e3181995ec2

Cited by 9 publications

(18 citation statements)

References 22 publications

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“…For patients who undergo resection, radiation, and chemotherapy, the 5-year survival rate is 33%. 1,67 The development of effective chemotherapy has been the main factor for overall improvement and disease-free survival among these patients; the 5-year survival rate is 70%. 53 A review of the St. Jude's Children's Research Hospital identified 344 patients with Ewing's sarcoma, of which 33 tumors were primary tumors in the vertebra.…”

Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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Section: Primary Bone Tumors Affecting the Atlantoaxial Skeleton Of Cmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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“…This is supported in part by one other case report detailing postoperative extramedullary proliferation after intramedullary nailing of bilateral humeral fractures in a patient with known multiple myeloma. Additionally, as in our patient, a neoplasm can simulate a localized abscess, 12 and a soft-tissue sarcoma can be misdiagnosed as an intramuscular hematoma. In this patient, fluid appearing to be gross purulence at the incision led to an erroneous diagnosis and treatment of an apparent postoperative infection.…”

Section: Discussionmentioning

confidence: 60%

Fulminant soft-tissue extension of anaplastic multiple myeloma masquerading as postoperative abscess

Murphy

Goorha

Heck³

2014

Current Orthopaedic Practice

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“…Radiographic evidence of calcification is rare with only a few previously described cases of metastases from the long bones or scapula. 5 Once discovered, prompt treatment must be performed to preserve function. Complete surgical removal of primary tumor is the preferred method of local treatment, whenever a marginal or wide resection is possible.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Radiating pain is the most common presenting complaint in patients with spinal tumors. 1,5 Neck pain is a common complaint in the pediatric population. One survey indicates it as the second most common pain in the preadolescent population, and the most persistent pain symptom, recurring in 21% of preadolescents once a month and 6.3% once a week.…”

Section: Introductionmentioning

confidence: 99%

Ewing's Sarcoma of the Cervical Spine

Dahm

Bhattacharjee

Huh

et al. 2017

J Pediatr Intensive Care

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In this article, we present the case of a 6-year-old female presented to the emergency department with progressive ascending motor weakness leading to cardiac arrest. The recent medical history included neck trauma 1 month prior to admission, 2 weeks of subjective fevers, and 1 day of urinary incontinence. After stabilization, and a review of the recent signs and symptoms, a magnetic resonance imaging of the neck revealed a posterior neck mass from C2 to T2. Neurosurgical removal of the mass was consistent with Ewing's sarcoma. Neck pain is a common presentation in the pediatric population, with the most common cause being traumatic. When coupled with neurological deficits, further studies are warranted to evaluate for organic causes.

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Primary Ewing Sarcoma of the Spine Mimicking a Psoas Abscess Secondary to Spinal Infection

Cited by 9 publications

References 22 publications

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Fulminant soft-tissue extension of anaplastic multiple myeloma masquerading as postoperative abscess

Ewing's Sarcoma of the Cervical Spine

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