Ewing sarcoma of the spine

Case contributed by Dr Matt Skalski

Presentation

Back pain and constitutional symptoms.

Patient Data

Age: 45
Gender: Female
Modality: X-ray

Unremarkable study of the lumbar spine. 

Modality: CT

A little over one year later, there is a poorly defined, mixed lytic and blastic lesion within the right lateral aspect of the L2 vertebral body. An associated heterogeneous soft-tissue mass extends from this lesion into the right retroperitoneal region inferior to the right renal artery. 

Modality: CT

Surface markers were placed over the right paraspinal region to the determine biopsy entry point. The medial marker and proper slice position were selected for optimal tumor access. A slightly medially oriented needle trajectory was used to avoid the kidney and obtain an adequate central core sample from the paraspinal mass. 

Modality: X-ray

The L2 vertebra and associated tumor has been resected, with replacement by an expandable titanium cage. The region is stabilized with bilateral pedical screw fixation from T11-L4 and anterior transverse fixation at the levels above and below L2.

Case Discussion

Ewing sarcoma is a rare tumor in those older than 25 years of age (95% affected are between 4 and 25 years of age), and also uncommonly involves the axial skeleton (~15% involve axis). In this case, the patient is both unusually old and affected in an uncommon location. 

Approximately 40% of Ewing tumors show some amount of sclerosis, but sclerosis is more common in affected flat bones than in long bones, and is a feature in this case. 

The differential diagnosis in this case includes: metastatic lesion (breast, gynecologic, etc), lymphoma, myeloma, chordoma, osteosarcoma, and other unlikely primary bone tumors. 

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Case Information

rID: 27763
Case created: 19th Feb 2014
Last edited: 13th Mar 2016
Inclusion in quiz mode: Included

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