Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4942-4948
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4942
Primary extraskeletal Ewing’s sarcoma of the lumbar nerve root: A case report
Li-Hui Lei, Feng Li, Tao Wu
Li-Hui Lei, Department of Spinal Surgery, Huaihua First People’s Hospital, Huaihua 418000, Hunan Province, China
Feng Li, Department of Technology, Hunan University of Medicine, Huaihua 418000, Hunan Province, China
Tao Wu, School of Medicine, Jishou University, Jishou 427000, Hunan Province, China
Author contributions: Lei LH designed, drafted and revised the manuscript; Li F approved the final version; Wu T acquired data and played an important role in interpreting the results; all authors contributed equally to this work, and have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Li, Doctor, Chief Doctor, Department of Technology, Hunan University of Medicine, No. 492 Jinxinan Road, Huaihua 418000, Hunan Province, China. hhlf2010@126.com
Received: September 30, 2021
Peer-review started: September 30, 2021
First decision: January 11, 2022
Revised: January 20, 2022
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: May 26, 2022
Processing time: 236 Days and 0.7 Hours
Abstract
BACKGROUND

Ewing’s sarcoma (ES) is a highly aggressive bone malignancy. Extraskeletal ES (EES) originating in the spinal canal is extremely rare. Herein, we report on a rare case of EES with a primary lumbar spinal nerve root including the complete diagnosis and treatment.

CASE SUMMARY

A young female patient presented with a complaint of right lower limb pain for 1 mo. Magnetic resonance imaging (MRI) revealed an 11 mm × 14 mm × 31 mm mass in the lumbar epidural region extending at the fifth lumbar spine (L5) level toward the right L5 neural foramen. Our initial diagnosis was an epidural schwannoma. The patient underwent total laminectomy, tumor resection and pedicle screw internal fixation and the L5 root tumor was found to have been completely removed intraoperatively. Histopathological examination of the lesion showed a typical ES with a large number of small, round cells. Immunohistochemistry analysis indicated positive CD99 and S100. After surgery, the patient received chemotherapy and radiotherapy with a 1 year of follow-up and no recurrent tumors or new lesions were found upon spine MRI and positron emission tomography/computed tomography reexamination.

CONCLUSION

Clinically, ES outside the bone should be considered when nerve root tumors are encountered inside and outside the spinal canal and the diagnosis should be determined by pathological biopsy. After surgical resection, chemotherapy and radiotherapy should be performed. After treatment, active follow-up and regular review should be completed.

Keywords: Primary extraskeletal Ewing’s sarcoma; Lumbar nerve root; Schwannoma; Case report

Core Tip: Ewing’s sarcoma (ES) is a very aggressive primary bone malignancy. Extraskeletal ES (EES) itself is rare, and primary intraspinal EES is even rarer, accounting for only 5% of all ES cases. Within the spine, these malignancies are typically located in the paravertebral and epidural spaces. Both domestically and internationally, most reported cases of EES have been found in the spinal canal. Primary nerve root EES is rare with only a few cases reported. Involvement of the lumbar nerve roots in EES has not been previously reported. Herein, we report a case of EES with primary intramedullary lumbar 5 nerve root including complete diagnosis and treatment.