Unusual Presentation of Thoracic Epidural Ewing Sarcoma in a 20-Year-Old Patient: A Case Report.

The aim of this case report is to present a rare case of epidural Ewing sarcoma with spinal cord compression, which is an uncommon presentation of this tumor. Ewing's sarcoma is a primary malignant tumor predominantly affecting individuals in their second decade of life, primarily impacting those aged 10 to 25, with the average age of onset being around 20 years. Epidemiological studies reveal that this cancer most commonly arises in the diaphyses of the long tubular bones in the lower extremities. Spinal involvement, however, is exceedingly uncommon. A case of sacral type of Ewing's sarcoma, with the most common localization of the primary spinal sarcomas and an extremely aggressive course, has been described in the literature. Other localizations of Ewing's sarcoma located in other areas of the spine are also presented. Even rarer are cases in which the tumor formation is located epidurally and exhibits marked medullary compression and absent neurological symptoms. We present the case of a 20-year-old patient who was admitted to the neurology department with symptoms of lower flaccid paraparesis and pelvic-reservoir dysfunction, specifically urinary retention for 16-17 hours, after which a catheter was added. MRI revealed an epidural tumor spanning TH5-TH7 vertebral levels, causing significant spinal cord compression. A CT scan of the chest identified a tumor on the left side at the level of the sixth rib, featuring soft tissue involvement, rib destruction, lung invasion, and a small pleural effusion. Due to the critical neurological symptoms, the patient underwent emergency surgery in the neurosurgical department, which included thoracic laminectomies, maximal possible tumor resection, and effective spinal cord decompression. Postoperative period was uneventful. Histopathological examination confirmed the diagnosis of Ewing's epidural sarcoma. The patient subsequently received adjuvant chemotherapy and radiotherapy. Six months post-treatment, the patient demonstrated a satisfactory overall condition with significant improvement in gait and continues to undergo chemotherapy courses.

Diagnostic Challenges of Sinonasal Pleomorphic Adenoma.

Pleomorphic adenomas (PAs) are benign tumors of the salivary glands. Rarely, they arise in the sinonasal cavity, presenting as well-defined, homogeneous soft tissue masses, causing expansive bony changes. The significance of PAs is the possibility of giving rise to malignant carcinoma - "carcinoma ex-pleomorphic adenoma" (CXPA).Here, we present the case of a 64-year-old female complaining of progressive unilateral congestion and external nose deformation, mostly along the left contour of the radix, with epiphora of the ipsilateral eye. Eventually, a tumor began protruding from the left naris. The computed tomography excluded osteolysis, while the surgical procedure discovered the inferior turbinate as the origin of the tumor. In addition, the ipsilateral maxillary sinus was found to have developed secondary sinusitis. After complete surgical excision, the histological result was sinonasal melanoma, but following no progression of the disease, a second pathologist with additional immunohistochemical markers (HMB-45 (human melanoma black 45) negative, Melan-A (melanoma antigen recognized by T-cells 1) negative, S100 (protein soluble in 100% ammonium sulfate at neutral pH) positive, panCK AE1/AE3 (pan cytokeratin antibodies AE1 and AE3) negative, p63 (tumor protein 63) negative, Ki-67 (marker of proliferation Kiel 67) 10%, CD68 (cluster of differentiation 68) negative, CK7 (cytokeratin 7) negative, and CDX2 (caudal-type homeobox 2) negative) placed the definitive diagnosis of PA.PA of the inferior turbinate is an extremely rare finding, with the clinical symptoms being unspecific. Sometimes, SOX-10 (SRY-box transcription factor 10) positivity can mislead to malignant melanoma, as in our case, which is why a broad panel of immunohistochemical markers is critical for the definitive diagnosis.

Myxopapillary ependymoma of filum terminale.

We report a case of 56-year-old patient suffering from myxopapillary ependymoma of filum terminale at the level of the fifth lumbar vertebra. The patient presented with progressive complaints of permanent pain in the anal and sacral region with duration of 8 months. When sneezing or attempting to do brisk movements, the pain irradiated to the posterior surface of the right thigh. Vertebral syndrome was absent. Neurological examination demonstrated no other abnormalities. Magnetic-resonance imaging showed intradural tumor of cauda equina at the level of the fifth lumbar vertebra. The present article discusses the role of MRI in the diagnosis of clinical cases presenting with atypical lumboradiculalgia. We have put an emphasis on the early diagnosis of myxopapillary ependymoma of filum terminale which has an impact on the surgical strategy and postoperative outcome.

A case of pelvic bone hydatidosis--diagnosis and treatment.

INTRODUCTION: Echinococcosis is a frequent helminthiasis in Bulgaria. Hydatid cysts commonly affect the liver and the lung. Echinococcosis rarely involves bones (0.5 to 2.5%) and vertebral column is affected in 50% of the cases. PATIENTS AND METHODS: We report a case of a 67-year-old female with echinococcosis of the pelvic bone clinically manifested by pain and swelling of the right iliac region and complicated by abscess of the surrounding soft tissue. The patient underwent surgery at the Department of Orthopedics and Traumatology, University hospital "St. George", Medical University, Plovdiv. Diagnosis was based on imaging findings, serologic and histological methods. Biopsy material was investigated by standard histological methods hematoxilin-eosin (H-E),PAS and hydrargyrum impregnation after Gommori, which presented both chitin and germinative membranes of the hydatid cyst. RESULTS: The patient underwent complete resection of the bone lesion along with the surrounding soft tissue. Purulent collection of 1200 ml was evacuated. A six months follow-up of the patient revealed no pathology of the cyst and other organs. She walked unaided. No echinococcosis recurrence was observed on control examinations. CONCLUSIONS: Hydatid bone disease is usually difficult to diagnose. Its treatment includes excision of bone lesion, curettage and oral therapy. It is not always possible to fully remove all the affected bone fragments especially when cysts are located in the femoral and pelvic bones. In the reported case the hydatid cyst was fully removed by resection of the right iliac ala and the patient's mobility was preserved.