The importance of surgery as part of multimodal therapy in rapid progressive primary extraosseous Ewing sarcoma of the cervical intra- and epidural space

  • Richard Bostelmann | richard.bostelmann@med.uni-duesseldorf.de Clinic of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany.
  • Mario Leimert Interdisciplinary Centre for Spinal Orthopedics, Hohwald Clinic, Neustadt in Sachsen, Dresden, Germany.
  • Hans Jakob Steiger Clinic of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany.
  • Kirstin Gierga Institute of Neuropathology, Heinrich Heine Univesity, Duesseldorf, Germany.
  • Athanasios K. Petridis Clinic of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany.

Abstract

Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma- like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression- free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.

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Published
2016-12-14
Section
Case Reports
Keywords:
Primary Ewing tumours, spinal canal, cervical spine, surgery, treatment, management, extra osseous.
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How to Cite
Bostelmann, R., Leimert, M., Steiger, H. J., Gierga, K., & Petridis, A. K. (2016). The importance of surgery as part of multimodal therapy in rapid progressive primary extraosseous Ewing sarcoma of the cervical intra- and epidural space. Clinics and Practice, 6(4). https://doi.org/10.4081/cp.2016.897