Cervical Ewing's sarcoma presenting as neurinoma

Considering their usual bone localisation, Ewing's sarcomas of soft tissues are rare. We report a case of a 19-year-old patient who had been suffering from cervico-brachial neuralgia followed by symptoms of progressive spinal cord compression. Magnetic resonance imaging detected a tumour at the C [7] level in the antero-lateral part of the spinal canal with an intracanal extension via an enlarged inter vertebral foramen, mimicking a neurinoma. The patient underwent an incomplete tumoural exeresis. The pathological examination yielded typical findings of Ewing's sarcoma. The patient underwent chemotherapy followed by complementary tumoural exeresis and radiotherapy. Literature review denotes the exceptional feature of the presentation. Correct and definitive diagnosis is made by pathological examination. Management of Ewing's sarcoma with the three main modalities: surgery, radiotherapy and chemotherapy increase the patient's survival

[Peripheral hypothyroidism and Cushing disease]

The presence of thyroid disorders in Gushing's syndrome is very common. These abnormalities demonstrate the effect of the cortisol on the different levels of hypothalamo-hypophyso-thyroid axis'. However, the association between primary hypothyroidism and Cushing s' syndrome is more rare. We report the case of a 55 year-old woman with a Gushing's disease because of pituitary macroadenoma. A primal]] hypothyroidism was diagnosed 8 years before in this patient because of obvious clinical features and was confirmed by decreased thyroid hormones levels and moderate TSH increase. Hypercortisolism induces a decrease in thyroid hormones, and changes in TSH wih less reactivity to TRH Suppression of hypercortisolism is associated with a normalisation of these functionnal thyroid disorders but also leads to an increase in autoimmune thyroiditis

Interacarnial hypertension revealing lumbar neurinoma

A 26-year-old woman was admitted with symptoms of raised intracranial pressure. On admission, neurological examination showed a bilateral papilloedema. There were no spinal, medullar or radicular sings and the brain computed tomography scan was normal. Lumbar puncture disclosed increased cerebrospinal fluid pressure [285 mm H2O]. CSF protein concentration was elevated [280 mg/dl] and glucose and cell counts were normal [respectively 56 mg/dl and 5 /mm3]. Magnetic resonance angiography eliminated a cerebral venous thrombosis. Considering the al-buminocytologic dissociation, a spinal magnetic resonance imaging [MRI] was done. It showed a cauda equina tumour. The patient underwent total resection of this intradural spinal tumour, via a posterior approach. The pathological diagnosis was neurinoma. A few weeks after surgery, symptoms of intracranial hypertension disappeared and eyes fundoscopy was normal. Similar cases in the literature were reviewed. Pathogeneses and mechanisms are discussed. We must keep in mind that some spinal tumours can appear under the mask of intracranial hypertension. Spinal MRI should be rapidly done avoiding delayed diagnosis and the risk of visual after-effects