Ewing Sarcoma of the Lumbar Spine With Lung Metastases in A 20-Year-Old Adult : A Rare Case Report

Abstract

Background: Ewing sarcoma (ES), a rare bone tumor primarily affecting adolescents and young adults, exhibits aggressive behavior, typically originating from bones or nearby soft tissues. Histopathology reveals a small round cell tumour, posing a challenge in distinguishing from small cell carcinoma, sarcomas, or lymphoma. This report outlines a 20-year-old man’s case of lumbar spine ES with lung metastases. 1.2. Case Report: A 20-year-old male complained of back pain radiating to both legs, particularly the right. No signs of paralysis were evident. Magnetic Resonance Imaging revealed a lumbar mass with extradural spread in the spinal canal, compressing the dural sac and extending through the intervertebral foramen, auto necrosis areas were identified which led to working diagnosis of Schwannoma. The surgical extraction of the lumbar mass was performed. Immunohistochemical analysis of operative material revealed small round tumour cells with CD99 positivity. Subsequently, a t (11; 22) (q24.3; q12.2) translocation was identified, confirming the histopathological diagnosis of Ewing sarcoma. Two months post-surgery, lung metastases and hypermetabolism in L2 vertebra, spinal cord, and TH11-TH12 tissue were detected. The next step in the patient’s treatment plan involves chemotherapy. 1.3. Conclusion: Ewing’s sarcoma, a fast-growing malignancy, requires a multidisciplinary approach due to its clinical and radiographic features. This report underscores the challenge of distinguishing primary bone Ewing sarcoma from bone metastasis of other small round cell malignancies. The tumour’s unusual location may complicate diagnosis, potentially leading to confusion with schwannoma. Early, precise diagnosis is crucial for prompt treatment