Ewing Sarcoma Beyond Adolescence:ARare Presentation of SpinalInvolvement in a 57-Year-Old Male

Ewing sarcoma is a rare malignant tumor typically seen in children and young adults, with very few cases reported in individuals over the age of 50. This case describes a 57-year-old male who presented with progressive bilateral hip and back pain, muscle wasting, and limited mobility. Imaging revealed a mass at the L1 vertebral level extending into the paraspinal soft tissues. Biopsy confirmed a diagnosis of Ewing sarcoma, with histology showing small round blue cells and strong CD99 immunoreactivity. Subsequent PET imaging identified a hypermetabolic lesion at L2, suggestive of metastasis. The patient underwent L1 laminectomy and was started on cabozantinib therapy. This case highlights the importance of considering Ewing sarcoma in older adults with atypical spinal or soft tissue lesions. Although rare in this age group, timely diagnosis is critical due to its aggressive nature and poor prognosis in older patients. Increased clinical awareness is essential for early recognition and treatment.