Due to the location of the mass and the presence of vascular encasement with splaying of the ICA and ECA, this mass was initially thought to represent a large cervical paraganglioma, either arising from the carotid body and/or vagus nerve. However, in view of atypical features (no intratumoral hemorrhage and lack of flow voids), a schwannoma could not be totally excluded.

She also had imaging features in keeping with left vocal cord palsy (confirmed on scope) and left hypoglossal nerve palsy, which correlates with her presenting symptoms.

The patient went on to have debulking surgery, and histopathology results showed Ewing sarcoma.

Extraskeletal Ewing sarcoma is rare compared to Ewing sarcoma of the bone. They tend to be aggressive, with a high rate of local recurrence and distant metastasis. In this patient, a post-operative PET scan showed no evidence of distant metastases.