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Vol. 33. Issue 5.
Pages 237-241 (September - October 2022)
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Vol. 33. Issue 5.
Pages 237-241 (September - October 2022)
Case Report
Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report
Sarcoma de Ewing epidural lumbar primario que se presenta como síndrome de la cola de caballo en un paciente adulto que se sometió a descompresión quirúrgica: informe de caso clínico
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Yao-Chung Yanga,b, Andrew Szu-Hao Liua,
Corresponding author
shliu@vghks.gov.tw

Corresponding author.
a Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
b National Defense Medical Center, Taipei, Taiwan
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Abstract

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.

Keywords:
Ewing's sarcoma
Lumbar spine
Pathological fracture
Resumen

El sarcoma de Ewing (SE) es una neoplasia primaria rara de la columna vertebral adulta lumbar y puede confundirse con un tumor benigno. En este caso, tras un historial del paciente de 3 meses de dolor en la parte inferior de la espalda y una rápida progresión de entumecimiento y debilidad en las piernas, una resonancia magnética (RM) mostró la presencia de una masa en la tercera vértebra lumbar. En un seguimiento de 2 meses, la imagen reveló una fractura, compresión y un agrandamiento de la lesión. La intervención de descompresión y fijación confirmó el SE, y el paciente inició una pauta combinada de radioterapia y quimioterapia. Dos meses después de la intervención, se sospechó SE residual en una RM. El paciente se sometió a una segunda intervención quirúrgica y la histopatología confirmó necrosis. Un seguimiento de 6 meses después de la primera intervención no mostró recidiva del tumor. Este caso respalda la inclusión del SE en el diagnóstico diferencial de las fracturas patológicas de la columna vertebral. La descompresión y fijación tempranas de la columna vertebral resultan cruciales para preservar las funciones neurológicas y vertebrales en el SE complicado con una fractura por compresión. El tratamiento combinado complementario de radioterapia y quimioterapia sigue siendo la estrategia terapéutica de referencia.

Palabras clave:
Sarcoma de Ewing
Columna vertebral lumbar
Fractura patológica

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