A Case Study of a 23 Year Old woman with Ewing’s Sarcoma

Introduction of the Study:

Ewing’s Sarcoma is the second most common primary sacral tumor. Ewing’s
Sarcoma’s are rare, aggressive tumors with tendency towards recurrence following resection of early
metastasis. Although peak incidences are between 10-20 years, patients of younger or older age
account for almost 30% of the cases.

A 23 year old woman is a known case of Ewing’s Sarcoma since October 2014. Patient
initially presented with back pain and weakness of both lower extremities. Patient underwent
laminectomy last October 2014 followed by 10 cycles of Chemotherapy. Patient was pronounced in
complete remission last September 2015. Patient had recurrence of back pain, 6/10 prickling in
character radiating to the left shoulder. This was also accompanied by weakness of both lower
extremities. MRI was done which showed multiple enhancing extramedullary lesions/nodules along the
cervical spine at the level of C7-T1 and at T12 levels with significant mass effect to the adjacent cord and
two enhancing nodules in the right cerebellopontine angle and vermis suggestive of metastatic disease.
Dr. Sy explained to the patient the ideal treatment for oligomets to the brain is stereotactic Radio
Surgery followed by whole brain Rad Therapy (WBRT). Due to financial constraints, the patient treated
at SLMS-QC for a palliative treatment of 30 Gy fractionated dose for about 2 weeks using 6 Mu linear
accelerator.

MRI may be of value in monitoring Ewing’s Sarcoma because it can check the discs and
nerves of the spine for conditions such as spinal stenosis, disc bulges and spinal tumors. It uses a
magnetic field and pulses of radiowave energy to make pictures of organs and structures inside the
body.

Patient Profile

Patient P.L.B is a 23 year old woman who lived at Hongkong Village Cabuyao Laguna. She was born in
Manila on January 14, 1993, daughter of Mr. Vitullano and Lourdes Buyson. She is Roman Catholic and a
Filipino citizen. She is single and has no occupation. Patient P.L.B was admitted for chemotherapy and
was diagnosed because of the case Ewing’s Sarcoma since 2014, that was seen using MRI imaged by Ms.
Maureen Casupanan, RT. And that was requested by Dr. Edwin S. Tan, FPCP, FPSMO, Internal Medicine
Oncology.
Patient History

Patient had a known case of Ewing’s Sarcoma since October 2014. Patient initially presented with back
pain and weakness of both lower extremities. Patient underwent laminectomy last October 2014.
Patient had recurrence of back pain 6/10 prickling in character radiating to the left shoulder and oliguria.
This was also accompanied by weakness of both lower extremities. Laboratory test of MRI were done
which revealed a spinal tumor. Biopsy of tumor revealed the above diagnosis. Patient underwent T1-T4
Laminectomy for excision of spinal tumor last 2014 of S/P 10 cycles of Chemotherapy (2015) and 10
cycles of Radiotherapy (2016). No signs and symptoms such as dysuria, fever, abdominal pain, headache,
vomiting and dizziness noted.

Personal and Family History

According to the patient chart, patient P.L.B is a non-smoker, non-alcoholic beverage drinker and denies
of using illicit drugs. Her mother and maternal grandmother has a history of DM and hypertension. And
her mother suffered Breast CA.

History of Patient Illness

She underwent radiotherapy and completed the session last January 10. Cranial and Thoracolumbar MRI
was requested which allegedly revealed tumor recurrence at the thoracic spine and metastasis to the
brain. Patient was transferred to St. Lukes Medical Center for another 10 sessions of radiotherapy.
Interval History did not show any new neurological deficit of any other symptom (dizziness, slurring of
speech, facial symmetry, seizure). She adviced another regimen of chemotherapy for the metastasis.