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Perry MT, Witten AJ, Marwan M, Vortmeyer A, Tailor J. Pediatric Prostatic Alveolar Rhabdomyosarcoma Presenting with Metastatic Spinal Cord Compression in the Thoracic Spine: A Case Report and Review of the Literature. Cureus 2024; 16:e56547. [PMID: 38646358 PMCID: PMC11027789 DOI: 10.7759/cureus.56547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Rhabdomyosarcoma (RMS) is a pediatric malignancy with a variable prognosis depending on tumor stage and genotype. There has been a significant improvement in survival rates over the past decades. However, aggressive variants can metastasize to locations that are difficult to treat. We report a case of prostatic alveolar rhabdomyosarcoma with metastases to the bone marrow and thoracic spine in a child. The patient was treated with a multimodal approach that included surgical resection of the epidural mass; the administration of vincristine, dactinomycin, and cyclophosphamide; and radiotherapy. Unfortunately, after six months, the patient showed disease progression and was started on secondary-line treatment. This case illustrates the difficulties in managing end-stage metastatic rhabdomyosarcoma and is the first report of prostatic rhabdomyosarcoma presenting with spinal cord compression in a child.
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Affiliation(s)
- Matthew T Perry
- Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Andrew J Witten
- Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Majeed Marwan
- Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Alexander Vortmeyer
- Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Jignesh Tailor
- Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
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Quraishi NA, Palliyil N, Hassanin MA, D'Aquino D, Shetaiwi A, Walker D. Malignant spinal cord compression in the paediatric population-a systematic review, meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4306-4313. [PMID: 37338630 DOI: 10.1007/s00586-023-07820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Malignant spinal cord compression (MSCC) has been noted in 3-5% of children with primary tumours. MSCC can be associated with permanent neurological deficits and prompt treatment is necessary. Our aim was to perform a systematic review on MSCC in children < 18 years to help formulate national guidelines. METHODS A systematic review of the English language was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search criteria included 'MSCC in children, paediatric and metastases' for papers published between January1999 and December 2022. Isolated case reports/case series with < 10 patients were excluded. RESULTS From a total of 17 articles identified, a final 7 were analysed (Level III/IV). Neuroblastoma constituted the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%). Soft tissue sarcomas were the most frequent cause of MSCC in children > 5 years old, while for neuroblastomas, the mean age of presentation was 20 months. The median age at time of diagnosis for the entire cohort of patients was 50.9 months (14.8-139). The median follow-up duration was 50.7 months (0.5-204). Motor deficits were the presenting symptom in 95.6% of children followed by pain in 65.4% and sphincter disturbance in 24%. There was a delay of about 26.05 days (7-600) between the onset of symptoms and diagnosis. A multimodality approach to treatment was utilised depending on the primary tumour. The prognosis for neurological recovery was found to be inversely proportional to the degree of neurological deficits and duration of symptoms in four studies. CONCLUSION Neuroblastoma is the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%), whilst soft tissue sarcomas constituted the most frequent cause of MSCC in children > 5 years old. The majority of patients presented with motor deficit, followed by pain. In children with neuroblastoma /lymphoma, chemotherapy was the primary treatment. Early surgery should be a consideration with rapid deterioration of neurology despite chemotherapy. A multimodality approach including chemo-radiotherapy and surgery should be the treatment of choice in metastatic sarcomas. It is worth noting that multi-level laminectomy/decompression and asymmetrical radiation to the spine can lead to spinal column deformity in the future.
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Affiliation(s)
- N A Quraishi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - N Palliyil
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Mohamed A Hassanin
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
- Department of Orthopaedic Surgery, Assiut University, Assiut, Egypt.
| | - D D'Aquino
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - A Shetaiwi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - D Walker
- Department of Paediatric Oncology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Bajaj A, Telfeian AE. Pediatric applications of endoscopic spine surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Bai J, Grant K, Hussien A, Kawakyu-O'Connor D. Imaging of metastatic epidural spinal cord compression. FRONTIERS IN RADIOLOGY 2022; 2:962797. [PMID: 37492671 PMCID: PMC10365281 DOI: 10.3389/fradi.2022.962797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 07/27/2023]
Abstract
Metastatic epidural spinal cord compression develops in 5-10% of patients with cancer and is becoming more common as advancement in cancer treatment prolongs survival in patients with cancer (1-3). It represents an oncological emergency as metastatic epidural compression in adjacent neural structures, including the spinal cord and cauda equina, and exiting nerve roots may result in irreversible neurological deficits, pain, and spinal instability. Although management of metastatic epidural spinal cord compression remains palliative, early diagnosis and intervention may improve outcomes by preserving neurological function, stabilizing the vertebral column, and achieving localized tumor and pain control. Imaging serves an essential role in early diagnosis of metastatic epidural spinal cord compression, evaluation of the degree of spinal cord compression and extent of tumor burden, and preoperative planning. This review focuses on imaging features and techniques for diagnosing metastatic epidural spinal cord compression, differential diagnosis, and management guidelines.
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Salomone G, La Spina M, Belfiore G, Bertuna G, Cannavò L, Catanzaro S, D'Amico S, Meli M, Musumeci A, Salvatorelli L, Scuderi MG, Spatola C, Valenzise M, Di Cataldo A, Russo G. Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager. BMC Pediatr 2021; 21:358. [PMID: 34429086 PMCID: PMC8383369 DOI: 10.1186/s12887-021-02834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Spinal cord compression (SCC) is an uncommon, severe complication of Hodgkin lymphoma (HL), occurring in 0.2% of cases at the onset and in 6% during disease progression. We present a teenager with SCC with clinical onset of HL; her pre-existing neurological abnormalities covered the presence of an epidural mass, which could have misled us. Case presentation A 13-year-old girl presented with a three-month history of lower back pain and degrading ability to walk. She suffered from a chronic gait disorder due to her preterm birth. A magnetic resonance imaging of the spine revealed an epidural mass causing collapse of twelfth thoracic vertebra and thus compression and displacement of the spinal cord. Histological examination with immunohistochemical analysis of the epidural mass demonstrated a classic-type Hodgkin lymphoma. Early pathology-specific treatment allowed to avoid urgent surgery, achieve survival and restore of neurological function. Conclusions Children and adolescents with back pain and neurological abnormalities should be prioritized to avoid diagnostic delay resulting in potential loss of neurological function. SCC requires a prompt radiological assessment and an expert multidisciplinary management.
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Affiliation(s)
- Giulia Salomone
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Milena La Spina
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Giuseppe Belfiore
- Unit of Radiology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Gregoria Bertuna
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Laura Cannavò
- Unit of Pediatrics, Hospital Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Stefano Catanzaro
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore D'Amico
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Mariaclaudia Meli
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Andrea Musumeci
- Unit of Radiology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Lucia Salvatorelli
- Unit of Anatomic Pathology, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Maria Grazia Scuderi
- Unit of Pediatric Surgery, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Corrado Spatola
- Unit of Radiotherapy, Department Ingrassia, Hospital Policlinico "G. Rodolico", University of Catania, Catania, Italy
| | - Mariella Valenzise
- Unit of Pediatrics, Hospital Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Andrea Di Cataldo
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy
| | - Giovanna Russo
- Unit of Pediatric Hematology Oncology, Department of Clinical and Experimental Medicine, Hospital Policlinico "G. Rodolico", University of Catania, Via Santa Sofia 78, Catania, Italy.
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Campillo-Recio D, Jimeno Ariztia M, Flox Benítez G, Marco Martínez J, Vicente Martín C, Plaza Canteli S. Metastatic spinal cord compression: Incidence, epidemiology and prognostic factors. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Campillo-Recio D, Jimeno Ariztia M, Flox Benítez G, Marco Martínez J, Vicente Martín C, Plaza Canteli S. Compresión medular metastásica: incidencia, epidemiología y factores pronóstico. Rev Clin Esp 2019; 219:386-389. [DOI: 10.1016/j.rce.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/31/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022]
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De Martino L, Spennato P, Vetrella S, Capasso M, Porfito C, Ruotolo S, Abate ME, Cinalli G, Quaglietta L. Symptomatic malignant spinal cord compression in children: a single-center experience. Ital J Pediatr 2019; 45:80. [PMID: 31300063 PMCID: PMC6626347 DOI: 10.1186/s13052-019-0671-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background Malignant spinal cord compression (MSCC) is associated withpoor prognosis and may lead to permanent paralysis, sensory loss, and sphincter dysfunction. Very limited data are available on incidence and etiology of MSCC in pediatric population. We aimed to examine etiology, clinical presentation and treatment of pediatric patient with MSCC admitted to the Santobono-Pausilipon Children’s Hospital, Naples, Italy. Methods Forty-four children under 18 yearsadmitedsince 2007 and assessed for MSCC clinical presentations, evaluation, and treatment.were retrospectively collected from our institutional pediatric oncology and neurosurgery database. Results The median age at time of MSCC diagnosis was 52 months, with a peak in young (≤3 years) patients. The leading cause of MSCC was extramedullary tumors (63.6%), in particular neuroblastoma (27.2%) followed by Ewing sarcomas (15.9%). Cord compression was the presenting feature of a new malignancy in 33 (75%) patients, and a consequence of metastatic disease progression or relapse in the remaining 11 (25%) patients. Motor deficit was the initial symptoms of spinal compression in all patients, while pain was present in about 60% of patients, followed by sphincteric deficit (43.2%). The primary tumor site was located in the neck in 3 (6.8%) patients, thorax in 16 (36.4%), cervico-thoracic region in 3 (6.8%), thoraco-lumbar region in 8 (18.2%), abdomen in 5 (11.4%), lumbar-sacral region in 7 (15.9%) and thoracic-lumbar-sacral region in 1 (2.3%). The median length of the interval between symptom onset and tumor diagnosis varied widely from 0 to 360 days in the entire population, however this interval was significantly shorter in patients with known neoplasia in comparisonto patients with new diagnosis (at relapse 7 days [interquartile range 3–10] vs at diagnosis 23 days [7–60]). Pre and post-operative spine magnetic resonance imagingwas performed in all cases, and most(95%) patients underwent neurosurgical treatment as first treatment. Severe motor deficit was associated with younger age and severe motor deficit at diagnosis was associated withworst motor outcomes at discharge from neurosurgery. Patients with progression or relapsed disease showed a worst prognosis, while the majority of patients (70.5%) were alive at 5 years after diagnosis. Conclusions The natural history of MSCC in children is associated to permanent paralysis, sensory loss, and sphincter dysfunction, thus prompt diagnosis and correct management are needed to minimize morbidity. Treatment strategies differed widely among cancer types and study groups in the absence of optimal evidence-based treatment guidelines. When the diagnosis is uncertain, surgery provides an opportunity to biopsy the lesion in addition to treating the mass.
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Affiliation(s)
- Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy.
| | - Piero Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Simona Vetrella
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Maria Capasso
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Carolina Porfito
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Serena Ruotolo
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Massimo Eraldo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
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Affiliation(s)
- John Joseph Collins
- Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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10
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Horn SR, Dhillon ES, Poorman GW, Tishelman JC, Segreto FA, Bortz CA, Moon JY, Behery O, Shepard N, Diebo BG, Vira S, Passias PG. Epidemiology and national trends in prevalence and surgical management of metastatic spinal disease. J Clin Neurosci 2018; 53:183-187. [DOI: 10.1016/j.jocn.2018.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 11/27/2022]
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Rades D, Schiff D. Epidural and intramedullary spinal metastasis: clinical features and role of fractionated radiotherapy. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:227-238. [PMID: 29307355 DOI: 10.1016/b978-0-12-811161-1.00015-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metastases involving the spinal epidural space and cord parenchyma are major sources of neurological impairment and decreased quality of life in cancer patients. Herein we review the clinical manifestations, pathophysiology, importance of early diagnosis and initiation of treatment, and role of fractionated radiotherapy of these disorders.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
| | - David Schiff
- Departments of Neurology, Neurological Surgery and Medicine, University of Virginia, Charlottesville, VA, United States
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Kraal K, Blom T, van Noesel M, Kremer L, Caron H, Tytgat G, van der Pal H. Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review. Pediatr Blood Cancer 2017; 64. [PMID: 28150396 DOI: 10.1002/pbc.26451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022]
Abstract
We performed a systematic review to define the long-term health problems and optimal treatment strategy for patients with neuroblastoma with intraspinal extension. Of 685 identified studies, 28 were included in this review. The burden of long-term health problems is high; a median of 50% of patients suffered from neurological motor deficit, 34% from sphincter dysfunction, and 30% from spinal deformity. The currently available literature remains suboptimal as a guide for treatment of NBL with intraspinal extension. More well-designed, prospective studies are needed to determine the optimal treatment strategy.
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Affiliation(s)
- Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Heleen van der Pal
- Department of Medical Oncology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
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Joaquim AF, Ghizoni E, Valadares MGC, Appenzeller S, Aguiar SDS, Tedeschi H. Spinal tumors in children. Rev Assoc Med Bras (1992) 2017; 63:459-465. [DOI: 10.1590/1806-9282.63.05.459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023] Open
Abstract
Summary Introduction: Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. Method: The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results: Multimodality radiological studies (plain films, 3D computed tomography scan and magnetic resonance imaging) are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis. As a general rule, a fine needle biopsy is recommended after radiological evaluation to confirm the tumor's histology. Primary bone tumors can be divided into benign bone tumors, mostly represented by vertebral hemangiomas, osteoid osteomas, osteoblastomas, aneurismal bone cysts, and eosinophilic granulomas, and malign or aggressive tumors, such as Ewing's or osteogenic sarcomas. Secondary bone tumors (spinal metastases) comprise different tumor histologies, and treatment is mainly based on tumor's radiosensitivity. The characteristics and treatment options of the main spinal tumors are discussed in details. Conclusion: Spinal tumors in children are rare lesions that demand a thorough understanding of their main characteristics for their proper management. Understanding the nuances of spinal tumors in children is of paramount importance for improving outcomes and chances of cure.
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Affiliation(s)
| | - Enrico Ghizoni
- Universidade Estadual de Campinas, Brazil; Centro Infantil Boldrini, Brazil
| | | | | | | | - Helder Tedeschi
- Universidade Estadual de Campinas, Brazil; Centro Infantil Boldrini, Brazil
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Rossi A, Fondelli M, Mattei R, Leone D, Donati PT. Le metastasi spinali in età pediatrica. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099500800214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Il rachide e il suo contenuto costituiscono in età pediatrica sede infrequente di localizzazione metastatica di neoplasie primitive del Sistema Nervoso Centrale o di altri organi. La classificazione delle metastasi spinali si basa attualmente sulla loro localizzazione in rapporto ai diversi compartimenti interessati: si distinguono pertanto metastasi extradurali, intradurali-extramidollari e intramidollari. A partire dal 1989, anno di introduzione della RM nel nostro Istituto, 123 bambini affetti da neoplasie primitive del Sistema Nervoso Centrale o di altri organi sono stati sottoposti a esame RM per la valutazione del rachide e del suo contenuto; in 13 di essi sono state riscontrate localizzazioni secondarie a tale livello. Si è messo in luce il comportamento neuroradiologico relativamente aspecifico delle metastasi stesse, che pone problemi talvolta complessi nella diagnosi differenziale sia con le neoplasie primitive che con processi patologici non neoplastici. Si ribadisce come la RM costituisca oggi la metodica elettiva per la ricerca e lo studio delle metastasi spinali, da eseguire anche all'esordio, anche se, a tutt'oggi, un ruolo di primo piano spetta ancora a indagini complementari, quali la citologia liquorale.
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Affiliation(s)
| | | | - R. Mattei
- Servizio di Neurochirurgia, Istituto Scientifico Pediatrico Giannina Gaslini, Genova
| | - D. Leone
- Servizio di Anestesia e Rianimazione, Istituto Scientifico Pediatrico Giannina Gaslini, Genova
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Ajiboye RM, Nelson SD, Shamie AN. Rare case of conus medullaris syndrome from a metastatic yolk sac tumor originating from the mediastinum of an adult male: a case report and review of the literature. Int J Spine Surg 2015; 9:59. [PMID: 26609514 DOI: 10.14444/2059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Yolk sac tumors (YST) are malignant neoplasms. They are a subtype of germ cell tumors and typically originate in the gonads although extragonadal origins of such tumors have been described. Yolk sac tumors are commonly found in the gonads of infants and children and are extremely rare in adults. The goal of this case report is to describe the clinical presentation of a rare case of metastatic extragonadal yolk sac tumor originating from the mediastinum and causing an acute conus medullaris syndrome in an adult male. METHODS A 47-year old male presented to our emergency department with a one-day history of bilateral lower extremity weakness, urinary retention and bowel incontinence. Imaging revealed a destructive lesion and a burst fracture of the first lumbar vertebral body (L1) with severe spinal canal stenosis. An urgent spinal decompression and fusion was performed. Oncologic workup revealed a yolk sac tumor originating from the mediastinum. RESULTS His neurologic function, including motor strength, bowel and bladder function improved in the postoperative period. Chemotherapy regimen of ifosfamide, etoposide and cisplatin was administered and radiation therapy was administered to the spine tumor bed. CONCLUSIONS Yolk sac tumors, although rare, should be considered in the long list differential diagnosis of an otherwise healthy male presenting with conus medullaris or spinal cord compression from metastatic disease without evidence of a testicular mass. Prompt diagnosis with urgent decompression of neural structures and stabilization of the spine may result in improvement in neurological function.
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Affiliation(s)
- Remi M Ajiboye
- UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Scott D Nelson
- UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Arya N Shamie
- UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA
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Henry M, Sung L. Supportive care in pediatric oncology: oncologic emergencies and management of fever and neutropenia. Pediatr Clin North Am 2015; 62:27-46. [PMID: 25435110 DOI: 10.1016/j.pcl.2014.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advancements in the care of children with cancer have, in part, been achieved through improvements in supportive care. Situations that require prompt care can occur at the time of presentation as well as during treatment. This article discusses the approach to children with fever and neutropenia, a complication encountered daily by care providers, as well as oncologic emergencies that can be seen at the time of a child's initial diagnosis: hyperleukocytosis, tumor lysis syndrome, superior vena cava syndrome, and spinal cord compression.
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Affiliation(s)
- Meret Henry
- Division of Hematology/Oncology, Children's Hospital of Michigan/Wayne State University, 3901 Beaubien, Detroit, MI 48201, USA.
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada
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Abstract
Although tumors of the central nervous system in children constitute the second most prevalent tumor type of childhood, spinal cord tumors account for less than 10% of pediatric central nervous system tumors. The most common are intramedullary, although they can be found in the extradural compartment or as intradural extramedullary masses. Extradural tumors can arise from bony elements, the meninges, or soft tissues. Neuroblastomas and sarcomas are frequently encountered along with bone tumors. Intradural extramedullary tumors can be meningeal or from distant sites and include meningiomas and schwannomas; most tend to be benign. Intradural intramedullary tumors, neuronal or glial, can be derived from neuroepithelial tissues. For the intramedullary tumors, astrocytomas represent around 60% of tumors, ependymomas 30%, and developmental tumors 4%. Such tumors require a multidisciplinary approach to ensure optimal patient outcomes. Spinal cord tumors most often present with pain followed by motor regression, gait disturbance, sphincter dysfunction or sensory loss, torticollis, and kyphoscoliosis. Treatment is based on tumor type, but surgical resection is the mainstay. Predictors of outcome include the histological grading, extent of resection, and neurological status at the time of surgery.
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Affiliation(s)
- Wesley Hsu
- Wake Forest Baptist Hospital, Department of Neurosurgery, Winston-Salem, North Carolina, USA.
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19
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Das SS, Chauhan A, Aromin M, Lotterman C, Warrier R. Acute onset of paraplegia in an adolescent with a soft tissue mass in the hand. Clin Pediatr (Phila) 2012; 51:398-400. [PMID: 22261547 DOI: 10.1177/0009922811433038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Lulla RR, Foy AB, DiPatri AJ, Fangusaro J. Emergencies in Children and Young Adults with Central Nervous System Tumors. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Burnelli R, Fabbri E, Guerrini G, Sperlì D, D'ambrosio A. Neurological presentation of Hodgkin lymphoma in the Italian Association of Pediatric Hematology and Oncology LH-2004 protocol. Leuk Lymphoma 2011; 52:1049-54. [PMID: 21534870 DOI: 10.3109/10428194.2011.562573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neurological symptoms can represent the first clinical manifestation of central nervous system (CNS) involvement in Hodgkin lymphoma (HL). Because of its rarity, it is often misunderstood for other pathological processes. We report two cases of pediatric CNS HL, presenting with neurological symptoms at diagnosis. We have also reviewed the literature and few cases are reported, only 19 of them concerning children. In both primary and metastatic CNS HL, all patients complained of neurological symptoms at presentation. Despite it being uncommon, physicians should regard the possibility of CNS localization in all children affected by HL presenting with neurological signs and/or symptoms.
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Affiliation(s)
- Roberta Burnelli
- Pediatrics Department, University Hospital Sant'Anna of Ferrara, Ferrara, Italy.
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22
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Khursheed N, Rumana M, Ramzan A, Zahoor S, Nisar S, Sarbjit C, Abrar W, Basharat M, Mohsin R, Kirmani A, Bhat R. Pediatric epidural tumors of the spine--experience of a decade from the Kashmir Valley. Pediatr Neurosurg 2011; 47:22-30. [PMID: 21613777 DOI: 10.1159/000327142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/07/2011] [Indexed: 11/19/2022]
Abstract
We present our experience after analyzing retrospectively the clinicopathological characteristics, surgical approaches, immediate and long-term postoperative complications and survival outcome of pediatric spinal epidural tumors treated over a period of 10 years from 2000 to 2009 in a tertiary-care hospital. Our study included benign and malignant tumors. The majority of our patients were boys (14:8). The duration of symptoms was longer in benign lesions. Non-Hodgkin's lymphoma was the commonest malignant tumor and aneurysmal bone cyst was the commonest benign tumor. The mean duration of follow-up was 19 months (range 3-48 months). Most of the patients improved in their neurological grade after surgery; however, the degree of excision had no bearing on the length of survival for malignant lesions.
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Affiliation(s)
- N Khursheed
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
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23
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Ewing sarcoma mimicking a peripheral nerve sheath tumor. J Clin Neurosci 2010; 17:1317-9. [DOI: 10.1016/j.jocn.2010.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 02/27/2010] [Indexed: 11/17/2022]
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24
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Latham GJ, Greenberg RS. Anesthetic considerations for the pediatric oncology patient--part 2: systems-based approach to anesthesia. Paediatr Anaesth 2010; 20:396-420. [PMID: 20199611 DOI: 10.1111/j.1460-9592.2010.03260.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
One of the prices paid for chemo- and radiotherapy of cancer in children is damage to the vulnerable and developing healthy tissues of the body. Such damage can exist clinically or subclinically and can become apparent during active antineoplastic treatment or during remission decades later. Furthermore, effects of the tumor itself can significantly impact the physiologic state of the child. The anesthesiologist who cares for children with cancer or for survivors of childhood cancer should understand what effects cancer and its therapy can have on various organ systems. In part two of this three-part review, we review the anesthetic issues associated with childhood cancer. Specifically, this review presents a systems-based approach to the impact from both tumor and its treatment in children, followed by a discussion of the relevant anesthetic considerations.
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Affiliation(s)
- Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E., Seattle, WA 98105, USA.
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Abstract
Hodgkin disease is a nodal disease. Spinal cord or root compression is a rare complication and usually seen in the setting of progressive, advanced disease. We report 2 cases of Hodgkin disease in pediatric patients who presented with neurologic signs. One patient had paravertebral masses and involvement of thoracic vertebrae, which was initially misdiagnosed as spinal tuberculosis. The second patient who presented with paraplegia and bladder and bowel involvement had an epidural mass with collapse of thoracic vertebra. Lymph node biopsy revealed Hodgkin disease, mixed cellularity in both the cases. Both were treated with chemotherapy followed by radiotherapy.
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Paravertebral malignant tumors of childhood: analysis of 28 pediatric patients. Childs Nerv Syst 2009; 25:63-9. [PMID: 18843494 DOI: 10.1007/s00381-008-0717-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the clinical features and treatment results of the primary paravertebral malignant tumors (PMTs) in our department. METHODS Medical records of 28 children with primary PMTs treated between 1988-2007 were analyzed retrospectively. RESULTS Primary PMTs constituted 4.8% of the cancer cases in our department. Tumor diagnoses were mostly neuroblastoma (46.4%) and soft tissue sarcomas (35.7%). These cases presented with pain (64.3%), motor dysfunction (42.8%), sphincter dysfunction (35.7%), palpable mass (32.1%), and sensory deficits (7.1%). All tumors were extradural. Physical examination revealed motor deficits (53.6%), deep tendon reflex alterations (53.6%), sphincter dysfunction (35.7%), pathologic reflexes (25%), abnormal cutaneous reflexes (25%), and sensory deficits (17.8%). Sixteen had cord compression (CC; 13 clinical, three radiological CC). Eleven of them presented with advanced disease. Seven were managed by surgical departments by primary surgery (three unresponsive). Others were managed by pediatric oncology: five with corticosteroids+/-chemotherapy (one unresponsive), one with radiotherapy (RT), and two with surgery for the clinical CC. Surgery was tumor excision in nine, laminectomy in nine, laminotomy in one, and delayed surgery after chemotherapy in two cases. In chemotherapy and surgery groups, there were neurologic sequela associated with the advanced disease at diagnosis in 38% and 37%, respectively. At 3-year median follow-up, nine patients died, 17 are alive (four with neurologic sequela), and two are lost of follow-up. CONCLUSION Majority of cases presented with advanced disease. Late referral is the major cause of morbidity and mortality. The CC caused by PMTs should be initially managed with corticosteroids +/- chemotherapy to avoid the adverse late effects of RT and surgery.
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Gebauer GP, Farjoodi P, Sciubba DM, Gokaslan ZL, Riley LH, Wasserman BA, Khanna AJ. Magnetic resonance imaging of spine tumors: classification, differential diagnosis, and spectrum of disease. J Bone Joint Surg Am 2008; 90 Suppl 4:146-62. [PMID: 18984727 DOI: 10.2106/jbjs.h.00825] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gregory P Gebauer
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224-2780, USA
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28
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Uehara S, Oue T, Yoneda A, Hashii Y, Ohta H, Fukuzawa M. Dumbbell-shaped Ewing's sarcoma family of tumor of thoracic spine in a child. Pediatr Surg Int 2008; 24:953-5. [PMID: 18542972 DOI: 10.1007/s00383-008-2183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2008] [Indexed: 11/29/2022]
Abstract
An 8-year-old boy was referred due to difficulty in walking. T1-weighted MRI detected a well-marginated lesion expanding from the epidural region in the spinal canal to the paravertebral area through the Th9 and Th10 intervertebral foramen. The patient underwent a biopsy under video-assisted thoracoscopy and the tumor was diagnosed as Ewing's sarcoma family of tumor (ESFT). Imaging confirmed that the tumor completely disappeared and his neurologic functions were recovered perfectly at the end of treatment. Very few cases of skeletal ESFT of epidural extension in childhood have been documented. Video-assisted thoracoscopic surgery remains the best option for the diagnosis of endothoracic tumors in children.
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Affiliation(s)
- Shuichiro Uehara
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadagaoka, Suita, Osaka, Japan.
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30
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Sciubba DM, Hsieh P, McLoughlin GS, Jallo GI. Pediatric Tumors Involving the Spinal Column. Neurosurg Clin N Am 2008; 19:81-92. [DOI: 10.1016/j.nec.2007.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Peterson EC, Alden TD, Patterson K, Lipson A, Friedman D, Garcia J, Avellino AM. Epidural metastases from endodermal sinus tumor arising from benign sacral teratoma. Case report and review of the literature. J Neurosurg 2007; 107:303-6. [PMID: 17941495 DOI: 10.3171/ped-07/10/303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The recurrence of benign sacral teratomas is a small but significant possibility. Recurrence as an endodermal sinus tumor (EST) with epidural metastases, however, has not been previously reported. The authors describe a case of a mature sacrococcygeal teratoma in a 4-day-old female patient that recurred after 22 months as an EST with epidural metastases. The child presented with abdominal pain, urinary retention, and difficulty walking. On imaging, a large pelvic mass and an epidural spinal mass were revealed. The patient's alpha-fetal protein (AFP) level was 68,000 ng/ml. Her neurological examination was significant for 3/5 plantar and dorsiflexion strength bilaterally. The patient underwent L-3, L-4, and L-5 bilateral laminectomies followed by subtotal resection of the recurrent pelvic tumor. Pathological testing of samples of both the recurrent pelvic and the extradural spinal tumors led to a diagnosis of EST. The patient underwent four cycles of chemotherapy with normalization of her AFP level to 13 ng/ml. In the weeks that followed, her AFP level steadily rose again to 167 ng/ml. Follow-up imaging revealed no tumor recurrence. The patient underwent a second course of chemotherapy followed by two tandem courses of high-dose chemotherapy with autologous stem-cell rescue. Since completing this therapy the patient has been clinically stable with an AFP level of 1.3 ng/ml for 14 months. At the 1-year follow-up examination, her plantar and dorsiflexion strength had markedly improved to 4+/5 bilaterally. To the authors' knowledge, this is the first case of a mature sacrococcygeal tumor that recurred as an EST and caused spinal canal compromise.
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Affiliation(s)
- Eric C Peterson
- Department of Neurological Surgery, University of Washington, Seattle, 98104-2499, USA.
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Peterson EC, Alden TD, Patterson K, Lipson A, Friedman D, Garcia J, Avellino AM. Epidural metastases from endodermal sinus tumor arising from benign sacral teratoma. J Neurosurg 2007. [DOI: 10.3171/ped.2007.107.4.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chang CY, Hung GY, Hsu WM, Kao SC, Hwang B, Hsieh YL. Retinoblastoma with spinal recurrence presenting as spinal cord compression. J Formos Med Assoc 2006; 105:497-502. [PMID: 16801038 DOI: 10.1016/s0929-6646(09)60190-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Central nervous system (CNS) involvement is not rare in extraocular retinoblastoma, and it is not surprising to find it in view of its route of spread. However, although spinal recurrence presenting as spinal cord compression (SCC) is a form of CNS involvement, it is extremely rare. This report describes two patients with unilateral retinoblastoma with spinal recurrence presenting as SCC. The first patient developed erythematous swelling of the right foot and weakness of the bilateral lower limbs at 7 months after left enucleation. Examination revealed pitting edema of bilateral feet and muscle power of 2+ to 3+, with intact sensory function. The second patient developed weakness of the bilateral lower limbs, and defecative and urinary difficulty for 2 days at 8 months after left enucleation. Examination revealed pitting edema of bilateral feet and muscle power of 2+, with defective sensory function. Both patients received surgery and local irradiation after SCC. The first patient refused chemotherapy and survived only 4 months due to disease progression. The second patient received systemic and intrathecal chemotherapy, and survived 19.5 months without disease progression. Spinal recurrence with SCC should be suspected when leg weakness or bowel or bladder disturbance occurs in patients with retinoblastoma.
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Affiliation(s)
- Chia-Yau Chang
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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35
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Abstract
Radiation therapy is an important and effective treatment modality when used in the management of oncologic emergencies. For any patient who has MSCC, ISCM, SVC syndrome, or life-threatening hemoptysis/obstruction, optimal management hinges on efficient multidisciplinary evaluation and communication to arrive at a treatment plan tailored to the individual patient. Optimal management may include steroids, surgery, chemotherapy, or bronchoscopic intervention. When radiation therapy is used, the total dose and fractionation schedule should be tailored to the disease setting and life expectancy of the patient.
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Affiliation(s)
- Young Kwok
- Department of Radiation Oncology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.
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36
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Mut M, Schiff D, Shaffrey ME. Metastasis to nervous system: spinal epidural and intramedullary metastases. J Neurooncol 2005; 75:43-56. [PMID: 16215815 DOI: 10.1007/s11060-004-8097-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer with an increasing incidence. Prostate, breast and lung cancer are the most common offenders. Metastasis usually arises in the posterior aspect of vertebral body with later invasion of epidural space. Pathophysiologically, vascular insufficiency is more important than direct spinal cord compression. The most common complaint is pain, and two thirds of patients with SEM have motor signs at initial diagnosis. Currently magnetic resonance imaging is the most sensitive diagnostic tool. The optimal management of SEM is still arguable, but recent advances in surgical management of SEM and higher complication rate of surgery following radiotherapy should persuade clinicians to consider de novo surgery where possible. Radiotherapy has an important role, particularly in treatment of radiosensitive tumors and in patients who are not candidates for surgery. Novel approaches such as stereotactic radiosurgery are promising; however, response to chemotherapy depends on inherent properties of primary tumor. Recurrent SEM is a substantial problem for which surgery or repeat radiotherapy may be options. Intramedullary metastasis is rare but should be considered in patients with systemic malignancy and asymmetrical presentation of myelopathic symptoms. The prognosis is usually poor and preferred modality of treatment is radiotherapy.
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Affiliation(s)
- Melike Mut
- Department of Neurosurgery, University of Virginia, Charlottesville 22908-0432, USA
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37
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Spinazzé S, Caraceni A, Schrijvers D. Epidural spinal cord compression. Crit Rev Oncol Hematol 2005; 56:397-406. [PMID: 16310372 DOI: 10.1016/j.critrevonc.2005.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Accepted: 04/15/2005] [Indexed: 11/27/2022] Open
Abstract
Spinal cord compression from epidural metastases (epidural spinal cord compression, ESCC) is the most common neurological complication of cancer after brain metastases. Extradural compression represents 97% of spinal cord metastatic lesions. ESCC usually occurs in patients with disseminated disease. The most common tumours associated with ESCC are lung and breast cancers, followed by lymphoma, myeloma, prostate cancer and sarcoma. ESCC represents a medical emergency because delayed treatment can be responsible for irreversible deficits, such as paralysis and loss of sphincter control. Patients with ESCC require a multidisciplinary diagnostic and therapeutic approach. Clinical suspect is radiologically detected for confirmation. The median expected survival time from diagnosis usually ranges from 3 to 6 months. The nature of the primary tumour and the degree of the neurological deficit are the most important factors affecting survival. The lack of prospective randomized trials makes the optimal treatment of ESCC controversial and the decision is to be tailored to the individual. Treatment options include: bed rest, administration of corticosteroids, surgery followed by radiation therapy, radiotherapy alone and, to a limited extent, chemotherapy and hormonal therapy.
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Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am 2005; 15:365-73. [PMID: 15450871 DOI: 10.1016/j.nec.2004.04.018] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spinal metastasis is the most commonly en-countered tumor of the spine and represents an ominous extension of neoplastic disease. Symptomatic spinal metastases produce a characteristic clinical syndrome beginning with local back or neck pain. All too often, the significance of presenting pain is not appreciated and correct diagnosis is delayed until more blatant manifestations of spinal cord or nerve root dysfunction are manifest. Pain is followed by weakness,numbness, and sphincter dysfunction. The natural history is one of relentless progression to complete and irreversible paralysis unless timely treatment is undertaken. Plain radiographs provide a simple and useful screening test. MRI is, however, the imaging method of choice, providing information concern-ing the level, location, and geometry of the spinal tumor as well as details concerning the bony integrity of the spine, particularly adjacent to a culpable tumor, all of which is essential to determine the management options and treatment strategies. Percutaneous image-guided biopsy is a useful test to establish a tissue diagnosis.
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Affiliation(s)
- Richard G Perrin
- Division of Neurosurgery, Department of Surgery, University of Toronto, St. Michael's Hospital, 55 Queen Street E. Suite 948, Toronto, Ontario M5C 1R6, Canada.
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40
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Baysefer A, Akay KM, Izci Y, Kayali H, Timurkaynak E. The clinical and surgical aspects of spinal tumors in children. Pediatr Neurol 2004; 31:261-6. [PMID: 15464638 DOI: 10.1016/j.pediatrneurol.2004.03.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
A series of 20 pediatric patients underwent surgery for spinal tumor at the Department of Neurosurgery, Gulhane Military Medical Academy between 1995 and 2003. Motor weakness and reflex changes were the main initial signs in these patients. Epidural tumors and intradural-extramedullary tumors were in equal number, and total tumor removal was achieved in most of the patients without adjuvant treatment. Laminotomy was the main surgical method in 60% of the patients with spinal tumor, especially in children younger than 3 years of age.
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Affiliation(s)
- Alper Baysefer
- Department of Neurosurgery, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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41
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Abstract
The management of patients with metastatic disease of the spine should be highly individualized and depends on several factors, including the clinical presentation, duration of symptoms, tu-mor type, anticipated radiosensitivity, tumor lo-cation, extent of extraspinal disease, integrity of the spinal column, and medical fitness and life expectancy of the patient. Early diagnosis and intervention are of paramount importance in improving the likelihood of functional neurologic recovery, with the maintenance of ambulation as the primary goal. Effective management of axial spinal pain involves reconstruction and stabilization of the spinal column. Although the ideal therapy has not been established, a wide range of management options is currently available.
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Affiliation(s)
- Adam S Wu
- Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
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42
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Abstract
Metastatic spinal disease is common in cancer patients, and it is a frequent source of pain and disability. Expert management of the patient's pain and neurologic dysfunction is required. Neurosurgical advances have afforded the patient the opportunity to have improved symptom management and improved quality-of-life outcomes. Patients and their families are best served by the provision of supportive care by specialty pain medicine and palliative care services (especially neurology based) working with the primary neurosurgical team in an integrated model.
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Affiliation(s)
- Sharon M Weinstein
- Huntsman Cancer Institute, University of Utah, Suite 2100, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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Cojean N, Entz-Werle N, Eyer D, Becmeur F, Kehrli P, Marcellin L, Christmann D, Babin A, Lutz P. [Dumbbell nephroblastoma: an uncommon cause of spinal cord compression]. Arch Pediatr 2003; 10:1075-8. [PMID: 14643537 DOI: 10.1016/j.arcped.2003.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Rarely children with Wilms' tumor develop spinal cord dysfunction by metastatic spread into the epidural space or the cord parenchyma. In the case reported here, the mechanism of spinal compression was different. CASE REPORT The authors report the clinical course of a 2-month-old boy with retroperitoneal extrarenal Wilms' tumor below the left kidney, characterized with a spinal cord compression developed through the intervertebral foramina. CONCLUSION Abdominal tumor, usually corresponding to neuroblastoma, may be a nephroblastoma.
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Affiliation(s)
- N Cojean
- Service de pédiatrie III, CHU de Hautepierre, avenue Molière, 67098 Strasbourg, France
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Buyukavci M, Karacan M, Olgun H, Tan H. Significance of bone marrow examination in the diagnostic process of paraspinal mass in children: a case report. J Pediatr Hematol Oncol 2003; 25:822-3. [PMID: 14528110 DOI: 10.1097/00043426-200310000-00018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spinal cord compression is a rare but serious complication of non-Hodgkin lymphoma or leukemia. Biopsy of the mass with or without laminectomy would be necessary for diagnosis in patients presenting with isolated paraspinal mass in the absence of other overt clinical symptoms or findings or laboratory abnormalities that would specifically suggest leukemia or lymphoma. The authors describe a 6-year-old girl with symptoms of spinal cord compression due to a paraspinal mass who had undergone surgical intervention; she was later shown to have acute B-cell lymphoblastic leukemia. A bone marrow aspiration should be considered in such patients to avoid unnecessary surgical intervention.
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Abstract
Back pain and suspected spinal cord compression remains one of the most frequent reasons for neurologic consultation in cancer patients. While treatment generally results in stabilization or improvement, early diagnosis remains the cornerstone of improving neurologic outcome. This article reviews the clinical features, differential diagnosis, and management of neoplastic epidural spinal cord compression.
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Affiliation(s)
- David Schiff
- Neuro-Oncology Center, University of Virginia Medical Center, Box 800432, Charlottesville, VA 22908-0432, USA.
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47
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Affiliation(s)
- G Nicolin
- University of Oxford, Department of Paediatric Haematology and Oncology, Level 4, John Radcliffe Hospital, Headington, UK.
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48
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Pianca C, Pistamiglio P, Veneselli E, Viscardi E, Pession A, Alvisi P, Carli M, Donfrancesco A, Casale F, Giuliano MG, di Montezemolo LC, Di Cataldo A, Lo Curto M, Bagnulo S, Schumacher RF, Tamburini A, Garaventa A, Clemente L, Bruzzi P. Neuroblastoma with symptomatic spinal cord compression at diagnosis: treatment and results with 76 cases. J Clin Oncol 2001; 19:183-90. [PMID: 11134211 DOI: 10.1200/jco.2001.19.1.183] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To report on the treatment of patients with newly diagnosed neuroblastoma presenting with spinal cord compression (SCC). PATIENTS AND METHODS Of 1,462 children with neuroblastoma registered between 1979 and 1998, 76 (5.2%) presented with signs/symptoms of SCC, including motor deficit in 75 patients (mild in 43, moderate in 22, severe [ie, paraplegia] in 10), pain in 47, sphincteric deficit in 30, and sensory loss in 11. Treatment of SCC consisted of radiotherapy in 11 patients, laminectomy in 32, and chemotherapy in 33. Laminectomy was more frequently performed in cases with favorable disease stages and in those with severe motor deficit, whereas chemotherapy was preferred in patients with advanced disease. RESULTS Thirty-three patients achieved full neurologic recovery, 14 improved, 22 remained stable, and eight worsened, including three who become paraplegic. None of the 10 patients with grade 3 motor deficit, eight of whom were treated by laminectomy, recovered or improved. In the other 66 patients, the neurologic response to treatment was comparable for the three therapeutic modalities. All 11 patients treated by radiotherapy and 26 of 32 patients treated by laminectomy, but only two of 33 treated by chemotherapy, received additional therapy for SCC. Fifty-four of 76 patients are alive at time of the analysis, with follow-up of 4 to 209 months (median, 139 months). Twenty-six (44%) of 54 survivors have late sequelae, mainly scoliosis and sphincteric deficit. CONCLUSION Radiotherapy, laminectomy, and chemotherapy showed comparable ability to relieve or improve SCC. However, patients treated with chemotherapy usually did not require additional therapy, whereas patients treated either with radiotherapy or laminectomy commonly did. No patient presenting with (or developing) severe motor deficit recovered or improved. Sequelae were documented in 44% of surviving patients.
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49
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Abstract
Neurologic complications are common in children with cancer, but the literature dealing with this subject is sparse. Using a symptoms and signs approach, the most common causes for requesting a neurologic evaluation for this population are reviewed. The spectrum of neurologic symptoms in children with cancer differs from adults and requires the consulting neurologist to have a thorough knowledge of childhood cancer and its effects on the nervous system.
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Affiliation(s)
- N L Antunes
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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50
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Abstract
Spinal cord compression secondary to metastases is an infrequent complication of childhood cancer. We describe an infant with hepatoblastoma in whom cord compression developed because of extensive epidural metastases during treatment. This is a hitherto undescribed metastatic site for hepatoblastoma.
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Affiliation(s)
- M Jadhav
- Department of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit 48201, USA
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