A Primary Dumbbell-Shaped Cervical Extraskeletal Ewing’s Sarcoma in an Adult: A Case Report and Literature Review

Dumbbell spinal tumors get their hourglass or dumbbell shape from being constricted in the middle, with one part inside the spinal canal and the other extending outside of it. This is the case of a 37-year-old female who presented to the clinic with a left cervicobrachialgia and acroparesthesia. While radiographic imaging initially reported a well-defined dumbbell-shaped C7-T1 foraminal tumor consistent with a neurinoma, the pathology report obtained after surgical intervention came back positive for Ewing’s sarcoma, with no other locations of the tumor. The diagnosis was unexpected given the shape of the tissue and the rarity of the extraskeletal form of Ewing’s sarcoma (EES). Only 4 previous cases to date have identified a primary cervical dumbbell-shaped extraskeletal Ewing’s sarcoma in adults.

Extraskeletal Ewing’s sarcoma: outcomes and CT features of endoceliac lesions

Background To analyse the clinicopathological features and outcomes of patients with extraskeletal Ewing’s sarcoma (EES). The basic imaging characteristics of endoceliac lesions, which are always misdiagnosed preoperatively, are also summarised.Methods This study involved EES patients admitted to our centre between January 2000 and January 2020. Clinical data from patients with EES (n = 25) and computed tomography (CT) data from patients with endoceliac lesions (n = 8) were retrospectively reviewed.Results The sample comprised 18 males and 7 females with a median age of 30 years (range 1–72 years). Seven patients had EES originating from surface sites and 18 had EES originating from endoceliac sites. The median tumour size was 8.0 cm (range 2.5–17.0 cm). In total, 20% of patients had distant metastasis at diagnosis. In the univariate analyses, tumour size > 8 cm, undergoing surgery, and regional lymph nodes metastasis were risk factors for poor prognosis of EES. In the multivariate analysis, patients undergoing surgery and regional lymph node metastasis were independent predictors of overall survival (OS). Endoceliac EES cases frequently exhibited lobulated contour (87.5%), absence of calcification (75%), severe necrosis or cystic degeneration (75%), heterogeneous enhancement (100%), moderate enhancement (75%), ill-defined borderline (62.5%), and organ invasion (75%). Half of the patients with endoceliac EES had CT features of lymphadenopathy.Conclusions Comprehensive understanding of the clinicopathological and imaging features of EES is beneficial for diagnosis, development of therapeutic strategies, and accurate prediction of prognosis for this rare malignant tumour. The results suggest that evaluation of the status of regional lymph nodes is important for the treatment of EES.