Spinal Sclerosing Epithelioid Fibrosarcoma at the Cervicothoracic Junction

Sclerosing epithelioid fibrosarcoma (SEF) is an unusual variant of fibrosarcoma that was previously considered to be a low-grade tumor with an indolent course. To our knowledge, the spine is a rare primary site for SEF, with only a few cases reported to date.

We report a case of SEF occurring in the cervicothoracic spine of a 64-year-old man with complaints of neck pain and right hand tingling for 6 months before clinical presentation. Imaging revealed a large mass that extended from C5 to T1 in the right posterior paraspinal soft tissues, with involvement of the posterior elements from C6 to T1 and infiltration of the T1 vertebral body. We performed an en bloc spondylectomy and gross total resection of the tumor. Pathologic and immunohistochemical characteristics confirmed the diagnosis of SEF.

Because of the anatomic nature of the cervicothoracic spine and critical neurovascular structures that the tumor involves, a true en bloc resection might not be possible, but an oncologically sound excision is ideal.