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. 2012 Mar;3(3):721-725.
doi: 10.3892/ol.2012.550. Epub 2012 Jan 3.

Primary dumbbell-shaped Ewing's sarcoma of the cervical vertebra in adults: Four case reports and literature review

Qing Zhu  1 , Jisheng Zhang, Jianru Xiao
Affiliations

Primary dumbbell-shaped Ewing's sarcoma of the cervical vertebra in adults: Four case reports and literature review

Qing Zhu et al. Oncol Lett. 2012 Mar.

Abstract

Ewing's sarcoma is the second most common malignant bone tumor in children and adolescents. The 4 cases described in this study were diagnosed with dumbbell-shaped intraspinal and extraspinal Ewing's sarcomas. The incidence of dumbbell-shaped tumors of this type in the spine is 17.5%. These tumors are often misdiagnosed as neurogenic tumors (schwannoma, neurofibromatosis) or giant cell tumors based on imaging. Radiculopathy is more common than spinal cord compression in Ewing's sarcoma. Preoperative biopsy is strongly recommended. As soon as Ewing's sarcoma is diagnosed by pathology, the treatment should begin with 2-3 cycles of neoadjuvant chemotherapy. Anterior-posterior and posterolateral approaches are both recommended for exposing this tumor. Following surgery, chemotherapy is critical to lessen the rate of recurrence and metastasis and to prolong the survival time. However, radiotherapy should be used with caution, as the spinal cord is sensitive to radiation; local irradiation is suggested. The tumor is difficult to remove en bloc in the cervical spine. It has a high rate of recurrence and metastasis. Therefore, the prognosis of Ewing's sarcoma in the cervical region is poorer compared to that in the thoracic and lumbosacral regions.

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Figures

Figure 1
Figure 1
Case 1. Coronal T1-weighted enhanced MRI of cervical spine reveals a dumbbell-shaped intraspinal and extraspinal mass. MRI, magnetic resonance imaging.
Figure 2
Figure 2
Case 1. Paraffin section by H&E staining. H&E, hematoxylin and eosin.
Figure 3
Figure 3
Case 1. The tumor (arrow) is exposed by the anterior approach.
Figure 4
Figure 4
Case 2. Axial T2-weighted MRI of the spine reveals a dumbbell-shaped soft-tissue mass compressing the spinal cord and left nerve root. MRI, magnetic resonance imaging.
Figure 5
Figure 5
Case 3. Axial T1-weighted enhanced MRI of the C7 vertebra reveals a soft-tissue mass invading the vertebral body and appendix. MRI, magnetic resonance imaging.
Figure 6
Figure 6
Case 3. paraffin section by H&E staining. H&E, hematoxylin and eosin.
Figure 7
Figure 7
Case 4. Coronal T1-weighted enhanced MRI of the cervical spine reveals the dumbbell-shaped intraspinal and extraspinal mass (arrow). MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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