Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 191-195
DOI: 10.4103/ajns.AJNS_190_20
Case Report

Epithelioid sarcoma of lumbar spine: A rare mesenchymal tumor masquerading as infection

G Sudhir
Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
,
S Jayabalan
Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
,
Amith Ram
Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
,
Saikrishna Gadde
Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
,
Karthik Kailash
Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Epithelioid sarcoma of the spine has been rarely reported in the literature. Its diagnosis is challenging due to nonspecific findings. We report a case of 42-year-old gentleman with back pain. Magnetic resonance imaging (MRI) revealed lesion in the L4 vertebral body extending into the spinal canal with pre and paravertebral involvement. He underwent posterior spinal decompression and instrumentation with biopsy. Histopathological examination was nonspecific. Considering clinical and radiological features, antitubercular treatment was initiated. The patient developed acute onset weakness of both lower extremities 1 month post-surgery. Repeat MRI and positron emission tomography (PET) computed tomography revealed an increase in the extent of lesion which required revision decompression. Histopathological examination showed cells with epithelioid appearance, positive for Vimentin, and epitheloid membrane antigen in immunohistochemistry. Radiotherapy was planned but the patient expired due to multiorgan dysfunction. Epithelioid sarcomas are rare soft-tissue neoplasms with poor prognosis. They can mimic infection and a high degree of suspicion is required in these cases to diagnose and treat them early.

Key-words:

Epithelioid sarcoma - infection - lumbar spine

Financial support and sponsorship

Nil.




Publication History

Received: 02 May 2020

Accepted: 28 December 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Armah HB, Parwani AV. Epithelioid sarcoma. Arch Pathol Lab Med 2009;133:814-9.
  • 2 Fisher C. Epithelioid sarcoma of Enzinger. Adv Anat Pathol 2006;13:114-21.
  • 3 Enzinger FM. Epitheloid sarcoma. A sarcoma simulating a granuloma or a carcinoma. Cancer 1970;26:1029-41.
  • 4 Steinberg BD, Gelberman RH, Mankin HJ, Rosenberg AE. Epithelioid sarcoma in the upper extremity. J Bone Joint Surg Am 1992;74:28-35.
  • 5 Prat J, Woodruff JM, Marcove RC. Epithelioid sarcoma: An analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis. Cancer 1978;41:1472-87.
  • 6 Romero JA, Kim EE, Moral IS. MR characteristics of epithelioid sarcoma. J Comput Assist Tomogr 1994;18:929-31.
  • 7 Ross HM, Lewis JJ, Woodruff JM, Brennan MF. Epithelioid sarcoma: Clinical behavior and prognostic factors of survival. Ann Surg Oncol 1997;4:491-5.
  • 8 Steib JP, Pierchon F, Farcy JP, Lang G, Christmann D, Gnassia JP. Epithelioid sarcoma of the spine: A case report. Spine 1996;21:634-8.
  • 9 Weisskopf M, Münker R, Hermanns-Sachweh B, Ohnsorge JA, Siebert C. Epithelioid sarcoma in the thoracic spine. Eur Spine J 2006;15 Suppl 5:604-9.
  • 10 Guillou L, Wadden C, Coindre JM, Krausz T, Fletcher CD. “Proximal-type” epithelioid sarcoma, a distinctive aggressive neoplasm showing rhabdoid features. Clinicopathologic, immunohistochemical, and ultrastructural study of a series. Am J Surg Pathol 1997;21:130-46.
  • 11 Levy A, Le Péchoux C, Terrier P, Bouaita R, Domont J, Mir O, et al. Epithelioid sarcoma: Need for a multimodal approach to maximize the chances of curative conservative treatment. Ann Surg Oncol 2014;21:269-76.
  • 12 Dina L. Epigenetic reprogramming of epitheliold sarcoma: A role for INI1-HDAC crosstalk. Archived from the original on 2015-04-22.
  • 13 Casanova M, Ferrari A, Collini P, Bisogno G, Alaggio R, Cecchetto G, et al. Epithelioid sarcoma in children and adolescents: A report from the Italian Soft Tissue Sarcoma Committee. Cancer 2006;106:708-17.
  • 14 Umar JM, Jason E, Elijah SM, Sean PS. Prognostic factors for survival in patients with epithelioid sarcoma: 441 cases from the SEER database. Clin Orthop Relat Res 2009;467:2939-48.
  • 15 Jason LH, Paola DC, Christopher DM. Loss of INI1 Expression is Characteristic of Both Conventional and Proximal-type Epithelioid Sarcoma. Am J Surg Pathol 2009;33:542-50.
  • 16 Piergiorgio M, Elena L, Federica F, Lisa G, Manuel RT, Silvana P, et al. SMARCB1/INI1 tumor suppressor gene is frequently inactivated in epithelioid sarcomas. Cancer Res 2005;65:4012-9.
  • 17 Lushnikova T, Knuutila S, Miettinen M. DNA copy number changes in epithelioid sarcoma and its variants: A comparative genomic hybridization study. Mod Pathol 2000;13:1092-6.
  • 18 Bhaskar K, Jinlong Y, Stefanie BM, Kenneth WT, Shermi YL, Li L, et al. The silencing of the SWI/SNF subunit and anticancer gene BRM in Rhabdoid tumor. Oncotarget 2014;5:3316-32.
  • 19 Chase DR, Enzinger FM. Epithelioid sarcoma. Diagnosis, prognostic indicators, and treatment. Am J Surg Pathol 1985;9:241-63.
  • 20 Yamato M, Nishimura G, Yamaguchi T, Tamai K, Saotome K. Epithelioid sarcoma with unusual radiological findings. Skeletal Radiol 1997;26:606-10.
  • 21 Yoo J. Epithelioid sarcoma of the spine: A case report and review. Open J Clin Diagn 2011;1:1-4.
  • 22 Li Y, Cao G, Tao X, Guo J, Wu S, Tao Y. Clinicopathologic features of epithelioid sarcoma: Report of seventeen cases and review of literature. Int J Clin Exp Pathol 2019;12:3042-8.
  • 23 de Visscher SA, van Ginkel RJ, Wobbes T, Veth RP, Ten Heuvel SE, Suurmeijer AJ, et al. Epithelioid sarcoma: Still an only surgically curable disease. Cancer 2006;107:606-12.
  • 24 Baratti D, Pennacchioli E, Casali PG, Bertulli R, Lozza L, Olmi P, et al. Epithelioid sarcoma: Prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 2007;14:3542-51.
  • 25 Chbani L, Guillou L, Terrier P, Decouvelaere AV, Grégoire F, Terrier-Lacombe MJ, et al. Epithelioid sarcoma: A clinicopathologic and immunohistochemical analysis of 106 cases from the French sarcoma group. Am J Clin Pathol 2009;131:222-7.
  • 26 Chanplakorn P, Chanplakorn N, Pongtippan A, Jaovisidha S, Laohacharoensombat W. Recurrent epithelioid sarcoma in the thoracic spine successfully treated with multilevel total en bloc spondylectomy. Eur Spine J 2011;20 Suppl 2:S302-8.