Primary Spinal Epidural Extraosseous Ewing's Sarcoma with Brachial Plexus Infiltration

Area of Science:

• Oncology
• Neurosurgery
• Pathology

Background:

• Ewing's sarcoma family of tumors are aggressive malignant small round blue cell tumors.
• Skeletal Ewing's sarcoma commonly affects long bones, pelvis, ribs, and sacrum.
• Extraosseous Ewing's sarcoma (EES) is a rare variant, typically presenting as a paravertebral mass.

Observation:

• A 25-year-old male presented with neck stiffness and progressive limb weakness.
• Cervical spine MRI revealed an anterior epidural mass compressing the spinal cord and extending along the brachial plexus.
• Imaging differentials included EES and lymphoma.

Findings:

• The patient underwent laminectomy with tumor resection.
• Histopathology confirmed the diagnosis of Extraosseous Ewing's sarcoma (EES).

Implications:

• EES presenting as an anterior epidural mass with neural plexus extension is exceptionally rare.
• Clinicians should consider EES in the differential diagnosis of anterior epidural masses in young adults.
• This presentation underscores the importance of considering rare diagnoses in neuro-oncology.