Primary Spinal Intradural Ewing Sarcoma pada Anak: Sebuah Laporan Kasus di Masa Pandemi COVID-19

Fauzan Herdian, Renindra Ananda Aman, Soehartati A Gondhowiardjo

Sari


Ewing Sarcoma (ES) merupakan kanker tulang primer nomor dua paling umum pada pasien anak. Manifestasi ekstraskeletal dari Sarkoma Ewing pada anak sangat jarang, terutama di rongga intradural pada tulang belakang.

Penulis melaporkan sebuah kasus yaitu seorang anak berusia 14 tahun yang dirujuk ke departemen kami dengan Sarkoma Ewing pada tulang vertebrae T11. Pasien sebelumnya mengeluh nyeri punggung bawah yang progresif disertai paraparesis dan kesulitan miksi. MRI spinal menunjukkan massa intradura ekstramedulla setinggi tulang vertebrae T11 tanpa perubahan patologis dari tulang vertebrae. Pasien menjalani laminektomi torakal dan memperoleh gross total resection. Diagnosis Sarkoma Ewing ditegakkan dari pemeriksaan histopatologi dan immunohistokimia. PET/CT pasca operasi menunjukkan tangkapan FDG minimal di intradura T11 tanpa gambaran metastasis. Keputusan dari pertemuan multidisiplin tumor board adalah kemoterapi adjuvan diikuti radioterapi lokal. Pasca kemoterapi, rencana pemberian radioterapi ditunda akibat pandemi COVID-19. Pasien dijadwalkan untuk kontrol rutin dan MRI spinal per 3 bulan.

Literatur menunjukkan diagnosis primary spinal intradural Ewing Sarcoma ditegakkan melalui pemeriksaan immunohistokimia dan/atau profil molekuler dengan pemeriksaan penunjang menyeluruh untuk menyingkirkan kemungkinan primer di daerah lain. Terapi diberikan sesuai penatalaksanaan untuk sarkoma ewing pada tulang yaitu kombinasi operasi diikuti kemoterapi dan radioterapi. Peran radioterapi pada Ewing Sarcoma ekstraskeletal saat ini terbatas untuk kontrol lokal dan direkomendasikan pasca reseksi subtotal. Radioterapi adjuvan dapat dihindari pada masa pandemi COVID-19 bila terbukti tidak meningkatkan kesintasan.


Kata Kunci


Sarkoma Ewing, Intradural, Ekstraskeletal, Anak

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DOI: https://doi.org/10.32532/jori.v11i1.106 <

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