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Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity

Rare entities are difficult to predict. They are considered last rightly, to expedite treatment and alleviate symptoms quickly. Rare presentations of rare diseases form a particularly difficult section of diagnoses that are not only impossible to predict but difficult to recognize, diagnose, and tre...

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Autores principales: Ganapathy, Sibhi, Subramaniam, Venugopal, Baliga, Vidya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335116/
https://www.ncbi.nlm.nih.gov/pubmed/32656151
http://dx.doi.org/10.4103/ajns.AJNS_371_19
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author Ganapathy, Sibhi
Subramaniam, Venugopal
Baliga, Vidya
author_facet Ganapathy, Sibhi
Subramaniam, Venugopal
Baliga, Vidya
author_sort Ganapathy, Sibhi
collection PubMed
description Rare entities are difficult to predict. They are considered last rightly, to expedite treatment and alleviate symptoms quickly. Rare presentations of rare diseases form a particularly difficult section of diagnoses that are not only impossible to predict but difficult to recognize, diagnose, and treat. Often the dilemma is to, investigate thoroughly saving time but financially burdening the patient and hospital, or, to investigate in gradual increments taking more time and effort, especially in rare cases where prolonged hospitalization and suffering occurs before the diagnosis is reached. This approach, however, wastes critically important time, which, especially in neurological compression, may often lead to irreversible deficits. This dilemma is admirably demonstrated in this case report of spinal Ewing's sarcoma. A young female presented to us with recurrent high cervical epidural collections presenting as compressive myelopathy. She underwent repeated decompressions, and the collection was misdiagnosed as tuberculosis, which was treated without empirical evidence, leading to significant irreversible disability. Finally, when she came to us, the histopathological assessment was done to reveal the diagnosis. Ewing's sarcomas, and indeed the whole gamut of small-round-cell malignancies, are great imitators. They are known to exist in the skull base mimicking schwannomas, chordomas, germinomas, pituitary adenomas, and even epidermoids and occasionally extend to the vertebral bodies and the cranio-vertebral Junction (CVJ) leading to instability and neurological compression. Here, they mimic vertebral tumors, discitis, infective abscesses, and even myeloma. Predictably, such an entity is diagnosed last, and diagnosed late, leading to bad consequences for the patient. Such was the fate of our patient. The report emphasizes the diagnostic dilemma and presents the need to use protocols for diagnosis and treatment, even in rare cases, to effect the best possible outcomes for patients. The use of a thorough diagnostic and management algorhythm prevents deeper and sinister disease processes from being missed.
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spelling pubmed-73351162020-07-09 Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity Ganapathy, Sibhi Subramaniam, Venugopal Baliga, Vidya Asian J Neurosurg Case Report Rare entities are difficult to predict. They are considered last rightly, to expedite treatment and alleviate symptoms quickly. Rare presentations of rare diseases form a particularly difficult section of diagnoses that are not only impossible to predict but difficult to recognize, diagnose, and treat. Often the dilemma is to, investigate thoroughly saving time but financially burdening the patient and hospital, or, to investigate in gradual increments taking more time and effort, especially in rare cases where prolonged hospitalization and suffering occurs before the diagnosis is reached. This approach, however, wastes critically important time, which, especially in neurological compression, may often lead to irreversible deficits. This dilemma is admirably demonstrated in this case report of spinal Ewing's sarcoma. A young female presented to us with recurrent high cervical epidural collections presenting as compressive myelopathy. She underwent repeated decompressions, and the collection was misdiagnosed as tuberculosis, which was treated without empirical evidence, leading to significant irreversible disability. Finally, when she came to us, the histopathological assessment was done to reveal the diagnosis. Ewing's sarcomas, and indeed the whole gamut of small-round-cell malignancies, are great imitators. They are known to exist in the skull base mimicking schwannomas, chordomas, germinomas, pituitary adenomas, and even epidermoids and occasionally extend to the vertebral bodies and the cranio-vertebral Junction (CVJ) leading to instability and neurological compression. Here, they mimic vertebral tumors, discitis, infective abscesses, and even myeloma. Predictably, such an entity is diagnosed last, and diagnosed late, leading to bad consequences for the patient. Such was the fate of our patient. The report emphasizes the diagnostic dilemma and presents the need to use protocols for diagnosis and treatment, even in rare cases, to effect the best possible outcomes for patients. The use of a thorough diagnostic and management algorhythm prevents deeper and sinister disease processes from being missed. Wolters Kluwer - Medknow 2020-05-29 /pmc/articles/PMC7335116/ /pubmed/32656151 http://dx.doi.org/10.4103/ajns.AJNS_371_19 Text en Copyright: © 2020 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Ganapathy, Sibhi
Subramaniam, Venugopal
Baliga, Vidya
Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title_full Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title_fullStr Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title_full_unstemmed Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title_short Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity
title_sort spinal ewing's sarcoma presenting as an epidural collection: a rare presentation of a rare entity
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335116/
https://www.ncbi.nlm.nih.gov/pubmed/32656151
http://dx.doi.org/10.4103/ajns.AJNS_371_19
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AT baligavidya spinalewingssarcomapresentingasanepiduralcollectionararepresentationofarareentity