Primary Ewing's sarcoma of the vertebral body: A case report

Abstract

Rational: The occurrence of Ewing's sarcoma in the vertebral body of elderly women is extremely rare, and the case of Ewing's sarcoma in the spine with secondary surgical repair after wrong diagnosis and treatment has not been reported. We report a case involving primary Ewing's sarcoma of the vertebral body in an elderly female. Owing to its rarity and controversial issues, we report a case report to discuss its clinical features, treatments, radiological, and histological characteristics.

Patient concerns: The elderly female patient came to see us with the manifestation of total paralysis of both lower limbs. The patient with a vertebral compression fracture as the primary manifestation was misdiagnosed in another hospital. The patient underwent inappropriate surgical treatment and was transferred to our hospital for diagnosis and second-stage surgery.

Diagnoses: The postoperative pathological examination and immunohistochemical examination in our hospital confirmed: Ewing's sarcoma; Surgical history at other hospitals suggests: after Bone cement injection.

Interventions: The patient underwent a T6 and T8 laminectomy and T5/6-T9 pedicle screw fixation.

Outcomes: Reexamination 1 month after the surgery showed that the tumor had been partially resected, the spinal cord compression was relieved, the tumor did not grow further, and the patient's lower limb physical ability, tactile sense, algesia and temperature sense recovered slightly.

Lessons: For patients with ewing's tumor in the spinal canal with symptoms of spinal cord compression, even if the patients with poor results after a unadvisable operation, it is still necessary to be actively in spinal cord compression by surgery. The differential diagnosis of Ewing's sarcoma and compression fractures is very important. For patients with vertebral tumors, special attention should be taken during vertebroplasty for bone cement leakage caused by excessive bone cement injection and increased local pressure. And some experience with imaging and laboratory findings.

Figure 1

Pre-operative thoracic spinal MRI shows compression fractures of T7, with central cavity of the vertebral body and high signal of local soft tissue.

Figure 2

Chest lateral DR, 9 months after surgery in another hospital shows visible T7 vertebral bone destruction and bulging to the surrounding.

Figure 3

Pre-operative 3D-CT of thoracic vertebrae in our hospital shows T7 flattening and visible hyperplasia of surrounding soft tissues and bone.

Figure 4

Pre-operative thoracic MRI in the lateral position, T1W1 low-signal shadow, T2W1 high-signal shadow, showing T7 vertebral destruction, bulging to the periphery, patchy mixed signal in and around the vertebral body, spinal cord distortion, and an intramedullary abnormal signal.

Figure 5

Microscopically, a large number of single, diffuse, dense small round cells were observed. Cytoplasm is few, nucleus is round, and staining is deep.

Figure 6

Post-operative thoracic MRI, showing the tumors that compressed the spinal canal in the rear have been cleared, the spinal cord compression has been relieved, and the tumor scope in the front has not been further expanded, internal fixation was performed again for stabilization.