Challenges in diagnosing and managing Ewing sarcoma in older adults: a case report of Ewing sarcoma presenting as seemingly uncomplicated back pain.

Ewing Sarcoma (ES) is a rare, aggressive malignancy typically seen in younger people, with diagnosis in older adults being uncommon. We present a case of a 70-year-old woman with ES. She presented with a common complaint of referred lower extremity pain that started without injury. However, unusual clinical features included generalized pruritus and nocturnal pain. Thus, it was decided to proceed with imaging. MRI revealed an intradural L3-L4 mass, initially suspected to be a schwannoma, considering homogenous contrast enhancement and no sign of invasion of the surrounding tissues. Her condition was not improving and was unresponsive to oral steroids. Surgical intervention yielded a pathology report confirming ES. She underwent radiation and chemotherapy but experienced complications, including thrombocytopenia and neutropenia. ES in older adults is rare, often presenting atypically and carrying a guarded prognosis. This case underscores the need for age-specific protocols and improved management strategies.