RARE CASE WITH LUMBAR EWING’S SARCOMA IN YOUNG ADULT: CASE REPORT

Objectives. Ewing’s sarcoma is a rare and aggressive tumour, typically arising from bones or soft tissue
around the bones. With an annual incidence of 1-3/ 1,000,000, it peaks in adolescents aged 10-20 years.
Associated with caucasian race and male sex. Ewing’s family of tumours (EFT) encompasses Ewing sarcoma
of bone (ESB), extraosseous Ewing sarcoma (EES), PNET and Askin’s tumour.
Patient 20yo male presented acutely with back pain radiating down both legs, especially right. No
paresis detected. Dysesthesia in L2 dextra innervation pool. Lumbar CT was carried out beforehand in an
outpatient setting.
MRI is performed to clarify the diagnosis. It revealed a pathological mass/tumour in lumbar level with
extradural spread in the spinal canal. Compression of the dural sac and spread through the intervertebral
foramen outside the spinal canal. Areas of autonecrosis are detected. Working diagnosis Schwannoma.
Patient was hospitalised in planned order for arranged surgery - Lumbotomy dxt, L2 dxt tumour’s
resection and Hemilaminectomy L1 and L2 dxt, Extirpation of tumour.
Postoperative control MRI reveals fluid in the operation site. Extensive oedema along deep muscles and
hemorrhagic fluid along m. psoas. Slight narrowing of the spinal canal, no stenosis here. There is most
likely a small amount of foraminal residual tissue in levels Th12-L1 and L2-L3, as well as altered body and
dorsal arch on the right side of the L2 vertebra on with sclerotic changes.
Upon discharge from the hospital patient notes numbness under the surgical wound, which decreases
dynamically. Neurologically no paresis, tactile and deep sensations are not disturbed. Surgical wounds heal
primarily.
Conclusions. Ewing’s sarcoma is a malignant, rapidly growing tumour that causes pain and can become
debilitating. A multidisciplinary approach and knowledge of the clinical, radiographic features and the
management of this entity are important.