A Rare Presentation of Extradural Ewing Sarcoma in the Lumbar Spine: A Case Report

Abstract

Introduction:  Ewing sarcoma (ES) is the most prevalent malignant bone tumor in children and adolescents, mainly impacting the axial skeleton and long bones. Extradural manifestations of Ewing sarcoma, particularly in the lumbar spine, are rare and may pose diagnostic challenges. This manuscript describes an unusual case of an epidural lumbar region, Ewing sarcoma, presented with acute neurological symptoms.

Case Presentation:  A 14-year-old male patient presented with a history of a fall resulting in paraparesis and urinary incontinence for the last 1 week. MRI revealed an extradural lesion compressing thecal sac at the L4-L5 level. An extradural hematoma or an ependymoma were the initial differentials, and intravenous steroids were commenced, resulting in partial relief of symptoms. Later on, a core needle biopsy and immunohistochemical staining were performed, confirming Ewing sarcoma with positive CD99 and vimentin. Surgical excision of the tumor was performed, achieving clear margins, and there was significant improvement in patient symptoms.

Discussion:  Lumbar epidural Ewing sarcoma in the lumbar spine is unusual and can result in acute neurological symptoms, creating a diagnostic dilemma. This case report testifies to the significance of maintaining high suspicion and emergency action for extradural spinal tumors. A complete surgical excision confirmed the diagnosis and improved the patient's neurology.

Conclusion:  Recognising a spinal tumor and swift treatment is vital to patient improvement, especially in acute cases. A delay can result in permanent neurological harm to the patient.