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Primary Ewing’s sarcoma of the vertebral column

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Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the demographics, imaging findings, clinical symptoms, and prognosis of primary vertebral Ewing’s sarcoma (PVES).

Design

A retrospective review of medical records and radiological studies of patients diagnosed with PVES from 1936 through 2001 in our institution and Department of Pathology consultation files was undertaken. Metastatic and soft tissue Ewing’s sarcoma cases were excluded.

Results

From a total of 1,277 cases of Ewing’s sarcoma, 125 (9.8%) had a primary vertebral origin. There were 48 females and 76 males. Patient ages ranged from 4 to 54 (mean 19.3, standard deviation 10.7, median 16) years. Vertebral column distribution was four cervical (3.2%), 13 thoracic (10.5%), 31 lumbar (25%), and 67 sacrum (53.2%). More than one vertebral segment was involved in ten cases (8%). Satisfactory imaging studies were available in 51 patients: 49 radiographs, 27 computerized tomography (CT), and 23 magnetic resonance imaging (MRI) studies. The majority of tumors were lytic (93%). Three cases were mixed lytic and sclerotic (6%) and one sclerotic. In the nonsacral spine, the majority of lesions (12/20) involved the posterior elements with extension into the vertebral body. Five cases were centered in the vertebral body with extension into the posterior elements. Two cases were limited to the posterior elements, and one case solely involved the vertebral body. Ala was the most frequently affected site in the sacrum (18/26). Spinal canal invasion was frequent (91%). Detailed clinical information was available in 53 patients. Duration of symptoms ranged from 1 to 30 (mean 7) months. Local pain was the first symptom and seen in all cases. Neurological deficits were present in 21 (40%) cases. All patients received radiation in various dosages; 70% additionally received chemotherapy. Twenty-five patients had surgery, and two patients received bone marrow transplantation. Forty-five patients had follow-up; the five-year disease-free survival probability is 0.53. Disease-free survival probabilities are 0.60 for sacral tumors and 0.45 for nonsacral tumors.

Conclusion

PVES is an uncommon tumor, usually seen in the second decade of life (mean age 19.3 years) with a male predilection (62%). An aggressive osteolytic lesion, particularly in the sacrum, should raise suspicion for this tumor in adolescents. Prognosis was similar in sacral and nonsacral tumors.

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Acknowledgements

The authors thank Ms. Linda Greene for manuscript preparation and Dr. J. Mandrekar, Ph.D., for statistical analysis.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Ch2–290 200 First Street, SW, 55905, MN, Rochester, USA

    Hakan Ilaslan & Murali Sundaram

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    K. Krishnan Unni

  3. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Mark B. Dekutoski

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  1. Hakan Ilaslan
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  2. Murali Sundaram
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  3. K. Krishnan Unni
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  4. Mark B. Dekutoski
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Correspondence to Murali Sundaram.

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Ilaslan, H., Sundaram, M., Unni, K.K. et al. Primary Ewing’s sarcoma of the vertebral column. Skeletal Radiol 33, 506–513 (2004). https://doi.org/10.1007/s00256-004-0810-x

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  • DOI: https://doi.org/10.1007/s00256-004-0810-x

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