A challenging diagnosis: Lesson from case series of sacral Ewing sarcoma.

BACKGROUND: Ewing's sarcoma is an aggressive bone and the surrounding soft tissue cancer primarily found in children and young adults. It is mostly observed in the trunk and long bones while unusually seen in the sacrum. Sacral Ewing sarcoma has a unique anatomic limitation due to neurological structures, vertebral column, and pelvic involvement. Hence, identifying sacral Ewing's sarcoma remains a challenge. METHOD: This is a case series including three patients diagnosed with Sacral Ewing's sarcoma. These three cases have been diagnosed based on clinical and radiographic examination, MRI, histopathology, and immunohistochemistry examination. DISCUSSION: Sacral Ewing's sarcoma remains a challenge to diagnose due to its unique anatomy site. MRI examination is sensitive to detect lesions but nonspecific. Thus, require histopathological confirmation. CONCLUSION: Early diagnosis of Ewing's sarcoma is essential and we need to perform further examinations, such as immunohistochemistry examination, to confirm the diagnosis of Ewing's sarcoma.

A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess.

INTRODUCTION AND IMPORTANCE: Spondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess. CASE PRESENTATION: We collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation. DISCUSSION: Patients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found. CONCLUSION: Treatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.