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Synchronous Low-Grade Central Osteosarcoma and Ewing Sarcoma: A Rare Case Report – Lumbar Fusion

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A 23-year-old female patient presented with symptoms of cauda equina syndrome and was diagnosed with Ewing sarcoma in the lumbar spine. Further imaging revealed a separate low-grade central osteosarcoma in the distal femur. These two rare and genetically unrelated tumors were found to be synchronous, with an exceedingly low probability of co-occurrence in a single individual. The patient underwent surgical decompression and resection for both tumors, with histological and molecular analyses confirming the diagnoses. This unique case highlights the importance of thorough workup and management of patients with rare and complex oncologic conditions

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

A 23-year-old female patient presented with radicular back pain, perineal numbness, and urinary retention. The patient was diagnosed with cauda equina syndrome and magnetic resonance imaging (MRI) of the spine revealed an enhancing osseous lumbar lesion causing severe central stenosis. A core needle biopsy of the lumbar spine showed microscopic features compatible with a small round blue cell tumor. CD99 and FLI1 were positive in the tumor cells. Next-generation sequencing demonstrated a…

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Int J Surg Pathol. 2024 Mar 20:10668969241239675. doi: 10.1177/10668969241239675. Online ahead of print.ABSTRACTA 23-year-old female patient presented with radicular back pain, perineal numbness, and urinary retention. The patient was diagnosed with cauda equina syndrome and magnetic resonance imaging (MRI) of the spine revealed an enhancing osseous lumbar lesion causing severe central stenosis. A core needle,

Int J Surg Pathol. 2024 Mar 20:10668969241239675. doi: 10.1177/10668969241239675. Online ahead of print.

ABSTRACT

A 23-year-old female patient presented with radicular back pain, perineal numbness, and urinary retention. The patient was diagnosed with cauda equina syndrome and magnetic resonance imaging (MRI) of the spine revealed an enhancing osseous lumbar lesion causing severe central stenosis. A core needle biopsy of the lumbar spine showed microscopic features compatible with a small round blue cell tumor. CD99 and FLI1 were positive in the tumor cells. Next-generation sequencing demonstrated a EWSR1::FLI1 fusion. Given these findings, the spine lesion was diagnosed as Ewing sarcoma. The patient underwent surgical decompression of L2. On further workup, an MRI revealed an ill-defined enhancing mass of the right distal femur. This area was biopsied, demonstrating a fibro-osseous lesion with osteoblast proliferation containing nuclear atypia, low mitotic activity, and SATB2 positivity, diagnosed as low-grade central osteosarcoma (LGCOS). The patient underwent resection, which showed a classic LGCOS by histomorphology. Although fluorescence in-situ hybridization study for MDM2 gene amplification was negative, the overall findings are most consistent with LGCOS. These neoplasms are considered to be synchronous due to the presentation of each entity within 6 months. Considering the aggregate yearly incidence of Ewing sarcoma (approximately 1 case per 750 000 per year) and LGCOS (approximately 1 case per 10 million per year), the aggregate yearly probability of developing both of these genetically unrelated tumors in a single individual is 1 per 7.5 trillion per year, and it is likely such an event has never happened in the past.

PMID:38504661 | DOI:10.1177/10668969241239675

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Synchronous Low-Grade Central Osteosarcoma and Ewing Sarcoma: A Rare Case Report

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Int J Surg Pathol. 2024 Mar 20:10668969241239675. doi: 10.1177/10668969241239675. Online ahead of print.ABSTRACTA 23-year-old female patient presented with radicular back pain, perineal numbness, and urinary retention. The patient was diagnosed with cauda equina syndrome and magnetic resonance imaging (MRI) of the spine revealed an enhancing osseous lumbar lesion causing severe central stenosis. A core needle

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