Clinical manifestation of Ewing's sarcoma as a retrotonsillar pharyngeal tumor

Ewing's sarcoma is a malignant tumour which usually arises from bony structures. It can be found in dia- or metaphysis of bones of the extremities but as well in 50% of cases in skeletal parts of the trunk. Clinically patients often present with various symptoms as there are pain, swelling and progredient loss of function if extremities are involved. But in many cases, Ewing's sarcoma shows a lack of specific symptoms and therefore stays inapparent for a long time. A 14-year-old patient complained about intermittent nuchal pain and was sent to hospital because of an extensive retropharyngeal swelling. The preoperative imaging showed a tumour of the soft tissue of the neck. It had reached the cervical spine and after surgical treatment it was histologically and molecular biologically diagnosed as a Ewing's sarcoma arising from the transversal processes of the atlas. Since Ewing's sarcoma may have an immense component of soft tissue it has to be included in the range of differential diagnosis of soft tissue tumours of the head and neck, e.g., as there are extracranial schwannoma, inflammatory lymph nodes or lymph node metastases and lateral and medial cysts of the neck.