Presentation
Female pediatric patient, with a history of trauma injury secondary to a fall from his own height, leading to acute urinary retention.
Patient Data
Bilateral ureteropyelocaectasia with bladder distension. Hypodense mass with presacral peripheral enhancement in the region of the right piriformis muscle and displacement of the rectum to the left.
Hypodense mass with presacral peripheral enhancement in the region of the right piriformis muscle (arrows).
A presacral mass located in the right piriformis muscle, T1 hypointense and T2 hyperintense with a hypointense wall. Diameters of 4x2.8x2.6 mm go from S2 right sacral foramen and into the spinal canal and move the rectum to the left.
A presacral mass located in the right piriformis muscle (arrows).
Pictures of the case on 3D printing
Ewing Sarcoma corresponds to the green mass
H&E: Small cell sarcoma, findings consistent with primitive neuroectodermal tumor and/or Ewing's sarcoma with extensive necrosis of the soft tissues of the presacral region.
Immunohistochemical: morphological and immunohistochemical findings consistent with primitive neuroectodermal tumor and/or Ewing's sarcoma of the soft parts of the sacral region.
Case Discussion
Ewing's sarcoma is a malignant, aggressive, relatively frequent tumor that occurs predominantly in adolescent age, affecting the metadiaphyseal layer of bone, occasionally with intramedullary extension.
Within the Ewing family of tumors is the variety of soft tissue involvement that manifests radiologically as a heterogeneous mass of extraskeletal extension, which generally does not affect bone tissue, although occasionally it can cause erosion or periosteal reaction due to mass effect on the bone structure.
Clinically, if it is in relation to the spinal column, as in this case, it is presacral in location. it can manifest as radicular pain, bladder or intestinal dysfunction.
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