Nonmetastatic Ewing's Sarcoma of the Lumbar Spine in an Adult Patient

Abstract

Although the spine is frequently involved in metastatic Ewing's sarcoma, primary involvement of the spine, beside sacrum, is much less frequent, especially in adult patients. Because of the low incidence of these tumors, there are currently no clinical guidelines outlining their management and a multitude of therapeutic strategies have been employed with varying success. The definitive management of Ewing's sarcoma of the spine, as in other locations, could include the combination of three main modalities: aggressive surgery, radiotherapy, and combined chemotherapy. Whenever possible, en bloc spondylectomy or extralesional resection is preferable, providing a better oncological result with a longer survival and a better preservation of the spine biomechanics. This is the lesson we learned about the case, we present here, of nonmetastatic lumbar localization by Ewing's sarcoma in as adult patient.

Figure 1

Preoperative MRI images showing an enhancing mass occupying the left hemivertebra, pedicle, and hemilamina of L2.

Figure 2

Postoperative CT scan demonstrating the tumor removal and the anterior column reconstruction.

Figure 3

Histopathological images revealing the typical aspect of a densely cellular “blue tumor” composed of small round cells uniformly arranged in sheets and with strong membranous CD99 immunoreactivity (H&H stain ×20, CD99 immunohistochemical stain ×20).