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Extraskeletal Ewing's sarcoma of the parapharyngeal space

Departments of ¹ Radiology, and ² Pathology, Chang Gung Medical College and Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kwei Shan, Tao Yuan, Taiwan

View larger version (106K): [in a new window]   Figure 1. (a) Axial contrast-enhanced CT at the level of the oropharynx shows a large, seemingly well-defined, inhomogeneously enhanced mass in the right parapharyngeal space with multiple small areas of low attenuation inside. Note the compromise of the regional airway and encasement of the adjacent carotid artery. (b) Axial contrast-enhanced CT at the level of the skull base and (c) coronal contrast-enhanced CT show irregular bony destruction of the right jugular fossa and hypoglossal canal, and intracranial invasion with perineural tumour spread. (d) Axial contrast-enhanced CT at the level of the sella shows right cavernous sinus invasion with obliteration of Meckel's cave and retrograde tumour extension to the right prepontine cistern.

View larger version (111K): [in a new window]   Figure 2. Axial CT image demonstrates the biopsy needle in place in the right parapharyngeal mass via the oblique retromaxillary approach.

View larger version (76K): [in a new window]   Figure 3. (a) Histopathology shows tumours cells with prominent nuclei but scanty cytoplasm (haematoxylin and eosin: x 132). (b) Immunohistochemical study for O-13 shows strong staining of the tumour cells.