Ewing Sarcoma At Sacral For a Young Adult Patient

Abstract

Introduction: Ewing's sarcoma is an aggressive bone and the surrounding soft tissue cancer. primarily found in  children and young adults. Ewing's sarcoma usually originates from the diaphysis rather than the metaphysis,  primary Ewing's sarcoma of the spine is considered a rare case [6], [7]. Etiology :- unknown . Epidemiology ;-less than 5% of all soft tissue sarcomas, The peak incidence is between 10 and 15 years, 30% of the cases arising in children under 10 and another 30% in adults over 20. male-to-female ratio of  3 to 1. Differential diagnosis :-neuroblastoma, rhabdomyosarcoma,neurosarcoma.  Evaluation. Clinical / Rapid progressive back pain and neurological deficit for Young Age .Radiological /  CT scan , finding osteolytic lesion at lumbo-sacro-iliac area ,MRI :- homogeneous lesions, with solid and  cystic components that are hyper-intense on T1 and T2 and irregularly enhancing. PET Scan metabolic active to staging metastatic other site and the Most definitive diagnosis is Biopsy for  histopathological , the best Treatment :-surgical decompression and resection of the tumor for  Biopsy.the factors infuence the outcome of afected patients. Young age , tumor volume <200 ml,  localized disease stadium, afected sacral levels of S2 and lower ,are factors associated with the most  favorable outcome regarding OS ,Radiotherapy +chemotherapy its complementary treatment .  Case report: A patient 17 years old male at high school , without past medical and surgical history admitted at  hospital for bilateral lumbosciatalgia for 10 months it was Rapid Progressive, Associated With  Hypoesthesia and intermittent claudication, patient denied history of trauma of fever , symptoms start  at left side back pain and then developed to weekness on the left limb and limitation of the walk ,  patient never report history of convulsion , or loss of consciousness , clinical examination patient  conscious GCS 15, well oriented and alert for place and people also time , and well cooperating , Walking  possible with lambing and standing more than 5minut is difficult ,Muscles lower limbs wasted glutei  bilateral more left Power/strength :- 3+/5 proximal and 3/5 distal left lower limb. Spine level ;-spinal deviation on the left side ,Positive doorbell sign pain on palpation laft spines of the  L5-S1,2, Painful palpation of the paravertebral muscle and spastic , Lasègue at 35 degrees ,Finger on the  ground not possible for pain. The all routine labs are normal , CTscan was done and shows , there is  osteolytic lesion on the left sacroiliac , and the completed with MRI , showed also mass lesion  heterogeneous , hyper intensity irregular which is suspect giant cell tumor , patient immidietlty plaining  toe OR to operated for decompression and biopsy , which is confirmed for Ewing sarcoma of sacral, post op patient immediately improved motoric and sensory and relieved by the pain and power of the left  lower limb is proximal 5/5 and distal 4+/5 , and transferred to radio and chemotherapy which the y  requested PET scan and finded pulmonary localization also . Conclusion ;- Ewing sarcoma of the sacral its very rare case and mostly effecting young age group , which will end up  handicap , and to diagnosis and treated early with effects outcome of the patient ,and to complete the  radio and chemotherapy its necessary and also to look out other locations.