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Intracranial extraosseous dural-based Ewing’s sarcoma with fluid-haematocrit levels: imaging findings of a rare tumour
  1. Sudipta Mohakud1,
  2. Aishvarya Shri Rajasimman1,
  3. Suvnedu Purkait2 and
  4. Suprava Naik1
  1. 1Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
  2. 2Pathology and Lab Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
  1. Correspondence to Dr Sudipta Mohakud; radiol_sudipta{at}


Extraosseous dural-based primary Ewing’s sarcoma of the central nervous system is a rare tumour posing a diagnostic challenge. On cross-sectional radiological imaging, the lesion has an extra-axial location with heterogeneous appearance. These lesions are usually multicystic with internal haemorrhage causing fluid-haematocrit levels. It mimics conditions like an aneurysmal bone cyst, microcystic meningioma, telangiectatic osteosarcoma or cystic metastasis. Exclusion of primary Ewing’s sarcoma or malignancy elsewhere in the body is required to rule out a secondary. Surgery along with adjuvant chemotherapy and focal radiotherapy is the preferred mode of treatment. Due to the presence of non-specific small round blue cells on H&E stain, these tumours are also confused with lymphoma, osteosarcoma, rhabdomyosarcoma, Merkel cell carcinoma, ependymoblastoma and neuroendocrine carcinoma. Immunohistochemistry provides a definitive diagnosis. A high degree of suspicion in the preoperative scans is crucial for prognostication and early management of this aggressive tumour leading to improved patient survival.

  • Radiology
  • Neuroimaging
  • Pathology
  • Neurooncology

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  • Contributors SM—conceptualisation, manuscript drafting, editing, reviewing. ASB—data collection, manuscript drafting, editing and reviewing. SP—manuscript editing, reviewing, data collection. SN—manuscript drafting, editing, reviewing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.