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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(11): 798-799
DOI: 10.1590/0004-282X20180096
Images in Neurology

Cavernous Sinus Ewing's Sarcoma

Sarcoma de Ewing do Seio Cavernoso

Authors

  • André Simis

    1   Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba SP, Brasil;

  • Carlos Eduardo Ribeiro De Moura

    2   Instituto de Oncologia de Sorocaba, Sorocaba SP, Brasil;

  • Fausto Carvalho

    3   Laboratório de Citologia e Patologia de Sorocaba, Sorocaba SP, Brasil.

  • Samuel Simis

    1   Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba SP, Brasil;
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Ewing's sarcomas (ES) are malignant tumors mostly found in children and young adults[1],[2],[3]. There are only six cavernous sinus ES reported in the literature[1],[2],[3],[4],[5].

A 21-year-old male presented with diplopia and left VI nerve palsy. Imaging revealed a lesion in the left cavernous sinus ([Figure 1]). A pretemporal craniotomy was performed with partial resection and recovery.

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Figure 1 A. post-contrast T1 MRI showing a peripheral contrast enhancing ovoid lesion measuring 2.1 x 1.6 x 1.6 cm in the left cavernous sinus. The center of the lesion is heterogeneously enhanced with hypointense areas that may denote necrosis. B. FLAIR sequence MRI showing a hyperintense lesion. C. and D. post-contrast coronal T1 MRI showing the tumoral relationship to the carotid artery, sphenoid sinus and middle cranial fossa. Differential diagnosis includes meningioma, lymphoma, pituitary tumor, carcinoma, neuroblastoma, rhabdomyosarcoma, small round cell sarcoma and hemangioma

The tumor consisted of small round cells on histopathological examination ([Figure 2]), positive for CD99, CD56, BCL-2 and Ki 67 positive in 10% of the cells and were negative for desmin, synaptophysin, GFAP, S-100 protein, CLA, cytokeratin 7 and 20, 34BE12, AE1/AE3, consistent with Ewing's sarcoma.

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Figure 2 Hematoxylin-eosin magnification x 40 showing an undifferentiated neoplasm, consisting of almost all small cells with oval or rounded nuclei, and scarce cytoplasm with indefinite limits. The cells are compactly arranged, without forming rosette structures.

 

Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Srivastava G, Jallo GI, Miller NR. Primary Ewing sarcoma of the cavernous sinus. Childs Nerv Syst. 2015;31(9):1583-8. https://doi.org/10.1007/s00381-015-2743-1
  • 2 Patibandla MR, G Uppin S, Thotakura AK, Panigrahi MK, Challa S. Primary Ewings sarcoma of cavernous sinus in an infant: a case report and review of literature. Turkish Neurosurgery. 2013;23(1)98-103. https://doi.org/10.5137/1019-5149.JTN.4131-11.1
  • 3 Kushen BSM, Gulbahce HE, Lam CH. Ewing's sarcoma of the cavernous sinus: case report. Neurosurgery. 2005;56(6):E1375.
  • 4 Idrees M, Gandhi C, Betchen S, Strauchen J, King W, Wolfe D. Intracranial peripheral primitive neuroectodermal tumors of the cavernous sinus a diagnostic peculiarity. Arch Pathol Lab Med. 2005;129(1):e11-15. https://doi.org/10.1043/1543-2165(2005)129<e11:IPPNTO>2.0.CO;2
  • 5 Pekala JS, Gururangan S, Provenzale JM, Mukundan Jr S. Central nervous system extraosseous Ewing sarcoma: radiologic manifestations of this newly defined pathologic entity. Am J Neuroradiol. 2006;27(3):580-3.

Address for correspondence

André Simis
R Joubert Wey, 290; 18030-095 Sorocaba SP
Brasil   

Publication History

Received: 02 April 2018

Accepted: 31 May 2018

Article published online:
22 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Srivastava G, Jallo GI, Miller NR. Primary Ewing sarcoma of the cavernous sinus. Childs Nerv Syst. 2015;31(9):1583-8. https://doi.org/10.1007/s00381-015-2743-1
  • 2 Patibandla MR, G Uppin S, Thotakura AK, Panigrahi MK, Challa S. Primary Ewings sarcoma of cavernous sinus in an infant: a case report and review of literature. Turkish Neurosurgery. 2013;23(1)98-103. https://doi.org/10.5137/1019-5149.JTN.4131-11.1
  • 3 Kushen BSM, Gulbahce HE, Lam CH. Ewing's sarcoma of the cavernous sinus: case report. Neurosurgery. 2005;56(6):E1375.
  • 4 Idrees M, Gandhi C, Betchen S, Strauchen J, King W, Wolfe D. Intracranial peripheral primitive neuroectodermal tumors of the cavernous sinus a diagnostic peculiarity. Arch Pathol Lab Med. 2005;129(1):e11-15. https://doi.org/10.1043/1543-2165(2005)129<e11:IPPNTO>2.0.CO;2
  • 5 Pekala JS, Gururangan S, Provenzale JM, Mukundan Jr S. Central nervous system extraosseous Ewing sarcoma: radiologic manifestations of this newly defined pathologic entity. Am J Neuroradiol. 2006;27(3):580-3.

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Zoom
Figure 1 A. post-contrast T1 MRI showing a peripheral contrast enhancing ovoid lesion measuring 2.1 x 1.6 x 1.6 cm in the left cavernous sinus. The center of the lesion is heterogeneously enhanced with hypointense areas that may denote necrosis. B. FLAIR sequence MRI showing a hyperintense lesion. C. and D. post-contrast coronal T1 MRI showing the tumoral relationship to the carotid artery, sphenoid sinus and middle cranial fossa. Differential diagnosis includes meningioma, lymphoma, pituitary tumor, carcinoma, neuroblastoma, rhabdomyosarcoma, small round cell sarcoma and hemangioma
Zoom
Figure 2 Hematoxylin-eosin magnification x 40 showing an undifferentiated neoplasm, consisting of almost all small cells with oval or rounded nuclei, and scarce cytoplasm with indefinite limits. The cells are compactly arranged, without forming rosette structures.