Temporal primary cerebral Ewing sarcoma extended to skull

. CASEA 30 year old female with a history of tonic-clonic generalized seizures and aphasia which started at 8 years old. She presented seizures characterized by loss of con -sciousness and tonic-clonic movements. Neurological examination showed absent corneal and nasal reflexes, right facial, central paresia, right hemiplegia, and ab-normal Babinski. The MRI showed a lesion enhance-ment tumor with low signal heterogeneous gadolinium enhancement, whereas signal intensity on T2-weighted images varies after contrast enhancement (Fig 1A). The spectroscopy showed an increase of coline and impor-tant diminution of N-acetil-aspartate (Fig 1B). The patient underwent left frontal craniotomy and the tumor was excised totally. Following surgery, she un -derwent whole brain, spine and local radiation therapy (30 Gy in total) and also received chemotherapy. She died 11 days after the surgery.Partial autopsy was performed, grossly; the tumor was an irregular glistening gray mass of 4×4 cm, which extended all along the temporal and parietal bone on the right side of the skull (Fig 1C). Tumor surfaced poorly demarcated firm areas, with necrosis, hemorrhage and dissemination along the skull base (Fig 1D).