Uncommon territory: Primary intracranial Ewing’s sarcoma in an adult patient

Abstract

Introduction: Ewing’s sarcoma is a rare malignant tumour predominantly affecting children and adolescents, typically originating in bone or soft tissue. Primary intracranial involvement is extremely rare, especially in adults. Most reported intracranial cases are dural-based and extra-axial, while intra-axial or mixed presentations are exceptionally rare.
Case report: We report a unique case of a 49-year-old male who presented with a generalised seizure and postictal dysphasia. Imaging revealed a large cystic (intra-axial) tumour with a mural solid component (extra-axial part) in the left temporoparietal region. Gross total resection was performed without complications. Histopathological and molecular analyses confirmed the diagnosis of primary intracranial Ewing’s sarcoma. Despite recommendations, the patient refused further oncological treatment and was lost to follow-up after three months, during which no recurrence was detected on imaging.
Conclusion: This case illustrates a rare adult presentation of primary intracranial Ewing’s sarcoma with mixed intra- and extra-axial features, highlighting the importance of considering rare entities in the differential diagnosis of atypical brain lesions. It also raises the possibility of post-surgical chronic inflammation as a potential factor in tumour pathogenesis, warranting further investigation.