Ewing's Sarcoma of the Thoracic Spine Associated with Paraplegia: Report of 1 case

Yoo, Young Mahn; Lee, Kwang Young; Moon, Myung Sun

Abstract

Since Ewing has reported a primary malignant tumor as medullary origin in 1921, the Ewing's sarcomas have been reported more than 1,000 cases in the literatures. The Ewing's sarcoma has frequent incidence in the long tubular bone but very rare in the skull and spine for primary malignant tumor of the bone. The incidence of the Ewing's sarcoma in the spine is very rare than in the skull. We experienced a case of Ewing's sarcoma of the thoracic spine which has associated a paraplegia as neurological deficit. A 24 years old Korean female has admitted to our clinical because of paraplegia with incontinence for 2 days. On admission, the neurological examination revealed a paraparesis below T3 level with urinary and fecal incontinence, and then local tenderness on T2 level. No fever and leucocystosis were checked. Only the ESR has elevated up to 38 mm/hr. The simple X-ray film of the thoracic spine has showed a mottled destruction of the T2 vertebral body and abscence of the pedicle shadow, which were more similar to the picture of malignant tumor(primary or metastatic) than the bony change of ostemyelitis. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion. We found a complete block at T2 level by myelography. Then the immediate total laminectomy on T2-3 was applied. The operative finding was a extradural mass, which has compressed the spinal cord. We removed the tumor mass incompletely but the decompression was enough. The neurologic deficit has improved gradually for post-operative 2 weeks, but the improvement of neurologic deficit has stopped to T10 sensory recovery. We performed a radiation therapy as 4500 rads dose for 4 weeks, but not further improvement has been found. The post-operative pathological diagnosis was Ewing's sarcoma as a anaplastic small cell type.