title: Spinal intradural metastasis from scapular Ewing sarcoma.
abstract: BACKGROUND
  Ewing sarcoma is a primary bone neoplasm, which is a high grade aggressive small round blue cell tumour, and is currently recognized as a part of the Ewing family of tumours. It is the most lethal bone tumor, and is a rare malignant bone tumor accounting for 10% of all primary bone tumors, and 6% of malignant bone tumors. It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians. It commonly occurs in long bones and pelvis but rarely involves the scapula. 85% of cases have metastasis within 2 years of diagnosis, rarely involving the meninges.
  
  
  METHODS
  We report a case of a 25 year old Sinhalese Sri Lankan female, presenting with a 1 day history of bilateral lower limb weakness and urinary incontinence. She had a sensory level with flaccid paralysis of lower limbs and a painless bony lump in the left dorsal scapula. Investigations showed scapular primary Ewing sarcoma giving rise to spinal intradural metastasis. For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.
  
  
  CONCLUSIONS
  Intradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.
authors.forename: Dissanayake Mudiyanselage Priyantha Udaya Kumara
authors.initials: DM
authors.lastname: Ralapanawa
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. kushaleej5@gmail.com.
authors.forename: Kushalee Poornima
authors.initials: KP
authors.lastname: Jayawickreme
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. imadhuekana@gmail.com.
authors.forename: Ekanayake Mudiyanselage Madhushanka
authors.initials: EM
authors.lastname: Ekanayake
authors.affiliation: University Medical Unit, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka. prabhashinikumarihamy@yahoo.com.
authors.forename: Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini
authors.initials: KW
authors.lastname: Kumarihamy
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis / Q000473:pathology; D012512:Sarcoma, Ewing / Q000473:pathology*; D012540:Scapula / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000556:secondary; D013355:Subdural Space