Magnetic resonance image findings of primary intradural Ewing sarcoma of the cauda equina: case report and review of the literature

Abstract

Background context: Involvement of the cauda equina in Ewing sarcoma (ES) is extremely rare, and only few cases are reported in literature. However, ES of cauda equina shares some neuroradiological features with other neoplasms that can involve the intradural space. Therefore, differential diagnosis with other tumors of cauda equina should be considered by neuroradiologists and neurosurgeons to provide appropriate treatment.

Purpose: To present a rare case of intradural extramedullary primary ES.

Study design: Case report.

Methods: We report a case of a 44-year-old woman presenting with the rapid onset of cauda equina syndrome. Radiological analysis showed multiple intradural masses, extending from L1 to S3 level. After radical surgery, lesions were histologically defined as ES. We present a literature review, analyzing magnetic resonance image (MRI) features of primary intradural ES of the cauda equina.

Results: Four cases of primitive ES arising from the cauda equina have been reported in the literature.

Conclusions: Because of the low number of reported cases, it is not possible to describe pathognomonic MRI findings for intradural ES of the cauda equina. However, few tumors show similar MRI features. Therefore, despite its rarity, intradural ES should be taken into account in the differential diagnosis of spinal tumors involving cauda equina.

Keywords: Cauda equina syndrome; Intradural extramedullary; Primary Ewing sarcoma.