Category: Neuroradiology, Region: Neck-Bones, Plane: Sagittal
A 20-year-old male patient was admitted with a two-month history of progressively worsening neck pain. Initial cervical spine computed tomography (CT) showed an enhancing right anterior epidural mass (0.9 x 3.8 cm) associated with spinal canal narrowing and irregularity of the C-3 vertebral body and posterior element. Subsequently, cervical spinal magnetic resonance imaging (MRI) performed revealed abnormal, hyperintense signals in the C-5 vertebral body posterior element and epidural soft tissue component causing spinal cord compression and edema. An interventional radiology image guided needle biopsy was then performed, and small round blue cell neoplasm was a concern. Immunostains were positive for CD 99 FLI 1 and negative for synaptophysin and chromogranin. Morphology and immuno profile made it suspicious for Ewing sarcoma. The fluorescence in situ hybridization (FISH) assay performed was inconclusive due to inadequate cells. During the hospitalization course, the patient received 10 mg of IV dexamethasone every eight hours. Nine days later, another biopsy was performed, also indicative of small round cell sarcoma. The patient was discharged while Ewing sarcoma gene and FISH results were still pending, however due to tumor location and new logical symptoms with tingling, Ewing sarcoma treatment was commenced, which improved the tingling symptoms. Further CT scans of the abdomen and thorax revealed splenomegaly, but otherwise no metastatic disease. The patient had a bone scan undertaking that showed focal activity in mid cervical spine suspicious for bony involvement. The EWSR1 gene break apart rearrangement studies that were performed were positive, supporting and confirming the final diagnosis of Ewing sarcoma of the cervical spine stemming from the C-5 vertebral body.