Primary ewing sarcoma in the uterine cervix with multiple bone metastases

A 45-year-old female (G1, P1) with HPV-52 infection and low-grade cervical cytology presented to our clinic with an asymptomatic cervical mass. She suffered amenorrhea for the past 3 years due to medication for thyroid cancer. Magnetic resonance imaging revealed a mass sized 7.1 × 6.3 × 5.7 cm in the cervix with local invasion, and multiple lesions in the left ilium and femur. Histologically blue small round cells, positive for CD99 and FLI-1, obtained by cervical biopsy and the EWSR1 gene rearrangement detected by Fluorescence in situ hybridization confirmed the diagnosis of Ewing sarcoma. However, prior to the first cycle of systemic chemotherapy, the patient developed a sudden onset of lower extremities paraplegia, with PET/CT detecting extensive metastatic lesions in multiple bones including cervical 4 and thoracic 10 vertebral bodies. Although we performed emergency spinal canal decompression and excision of a thoracic 10 metastasis, the patient's condition deteriorated rapidly and died three months later.