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Across seven cycles, imaging showed further tumor shrinkage and no recurrence, supporting multidisciplinary management when standard regimens in older patients remain 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\nPrimary Intracranial Ewing Sarcoma Arising from the Cavernous Sinus in an Older Woman with a History of Intensive Breast Cancer Treatment: A Case Report  \nTomoki KAWANO,1 Fumitaka MATSUMOTO,1 Shinji YAMASHITA,1 Nobuyuki OGURI,2 Keiichi AKIZUKI,3 Takumi TOMONAGA,4 Yuri AKIYAMA,4,5 Yoshihito KADOTA,6 Yoshinao ODA,4 Minako AZUMA,6 Atsushi YAMASHITA,2 and Yoshiko OKITA1  \n1 Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan 2 Division of Pathophysiology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan 3 Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine,  \nFaculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan  \n4 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan 5 Department of Diagnostic Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Fukuoka, Japan 6 Department of Radiology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan  \nAbstract  \nA 72-year-old woman with a history of breast cancer presented with left oculomotor nerve palsy. Magnetic resonance imaging revealed a progressive mass lesion in the cavernous sinus. Initially, TolosaHunt syndrome and metastatic brain tumor from breast cancer were suspected; however, radiological differentiation proved challenging. Pathological examination confirmed the diagnosis of primary intracranial Ewing sarcoma. The tumor exhibited progressive growth, and Gamma Knife radiosurgery was performed. After treatment, tumor shrinkage and symptomatic improvement were observed. Ewing sarcoma typically occurs in children and young adults; however, the safety and efficacy of chemotherapy in older populations remain largely unstudied. In this older patient, the rare location of the tumor within the cavernous sinus posed challenges to surgical resection. Chemotherapy was administered at a reduced dose of 50%, with limited side effects. After 7 cycles of chemotherapy, tumor showed further shrinkage, and no recurrence was observed. This case demonstrates that, even in rare tumors with unestablished chemotherapy protocols for older patients, satisfactory outcomes can be achieved with accurate pathological diagnosis and a multidisciplinary treatment approach.  \nKeywords: primary intracranial Ewing sarcoma, cavernous sinus, older patient  \nIntroduction  \nPrimary intracranial Ewing sarcomas (ES) and peripheral primitive neuroectodermal tumors (pPNETs) are rare malignancies that predominantly occur in children and adolescents.1) Although the most common sites are the long bones, extraosseous ES/pPNETs have been reported in soft tissues and other anatomical locations. In contrast, only 1%-2% of ES/pPNETs are found intracranially.2) These tumors are rare in adults, particularly, in older popula-  \ntions. The fusion of the EWSR1 gene with a member of the ETS gene family is considered the primary driver of tumorigenesis in ES/pPNETs, and molecular testing for EWSR1 rearrangement remains the gold standard for diagnosis.3,4) In the 2020 World Health Organization (WHO) classification, typical ES and pPNET were integrated into a single entity, now collectively referred to as ES.5) Consensus regarding the optimal treatment strategy for primary intracranial ES has yet to be established. Although surgical resection is the mainstay of management,3) chemotherapy  \nReceived May 7, 2025; Accepted July 22, 2025  \nCopyright Ⓒ 2025 The Japan Neurosurgical Society  \nThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.  \n526 T. Kawano et al.  \nFig. 1 Gadolinium-enhanced magnetic resonance imaging (MRI) findings.  \nA. Initial MRI demonstrated a mass lesion extending from the left cavernous sinus to the sella turcica.  \nB. Follow-up MRI performed four months later showed tumor prog","cbCailNg7xYVeGRy","https://ap.wps.com/l/cbCailNg7xYVeGRy","pdf",985567,"English","# Abstract\n# Keywords\n# Introduction\n# Case Report","[{\"question\":\"Why was the initial diagnosis challenging in this case?\",\"answer\":\"The MRI findings suggested Tolosa-Hunt syndrome or metastatic brain tumor from breast cancer, and radiological differentiation proved difficult before pathology confirmed Ewing sarcoma.\"},{\"question\":\"What treatments were used after the pathological diagnosis?\",\"answer\":\"Gamma Knife radiosurgery was performed, followed by chemotherapy administered at a reduced dose of 50%.\"},{\"question\":\"What was the clinical and radiological outcome after treatment?\",\"answer\":\"After seven cycles of reduced-dose chemotherapy, the tumor continued to shrink and the patient showed symptomatic improvement, with no recurrence observed.\"}]","Primary Intracranial Ewing Sarcoma Arising from the Cavernous Sinus in an Older Woman - A Case Report | PDF",1790695088,15]