PMC9553509_01
Large bilateral nape of neck swelling.
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Examination showed a large bilateral nape of neck swelling measuring approximately 15 x 15 cm as one piece, firm in consistency and with smooth margins (Figure 1).
Cervical MRI: (a) coronal T1-weighted MRI and (b) axial T2-weighted MRI imaging of the cervical spine showing a posterior neck bilobed soft tissue mass showing heterogenous intermediate signal on T1 & T2 (c) axial slice of a preoperative T1 postgadolinium contrast showing patchy and reticular post contrast enhancement. MRI, magnetic resonance imaging.
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It also shows c2/3/4/5 interspinous extension with elevated marrow signal of their spinous processes and relative central canal narrowing (Figure 2).
The mass post excision.
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The mass was massive and invading the outer surface of the spinous process; it was shaved off with the attached muscles (Figure 3).
(a) Immunohistochemically, the tumor cells show diffuse membranous expression for CD99. (b) Scanning magnification (H&E stain) shows a malignant small round blue cell tumor arising from surrounding soft tissue. (c) At lower magnification (H&E stain 10x), a highly cellular, high-grade sarcoma with a dense solid- to sheet-like distribution of small round blue cells is observed histologically.
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The histopathology results after surgery confirmed the diagnosis of Ewing's sarcoma (CD99 positive) (Figure 4).