Primary germinoma of the spinal cord: a case report with 28-year follow-up and review of the literature

Germ cell neoplasms occur in extra-gonadal midline locations of the retroperitoneum, mediastinum, pineal gland, areas of the suprasellar cistern, and rarely in the spinal cord. We recently reviewed a case of an unresectable lumbar spinal cord tumor in a 16-year-old female previously diagnosed as metastatic poorly differentiated carcinoma. An extensive evaluation for a primary neoplasm at that time was unsuccessful and the patient was treated with local radiation therapy. Recently, additional histochemical and immunocytochemical studies were performed on the archival formalin-fixed paraffin-embedded material and the clinical history was reviewed. These ancillary studies (including positive immunohistochemical staining for placental alkaline phosphatase) support a diagnosis of intramedullary germinoma of the conus medullaris. This patient has enjoyed 28 years of disease free survival which reflects the radiosensitive nature of this neoplasm. These data lend support to the existence of a primary germinoma in the spinal cord and illustrate the utility of using histochemical stains and immunohistochemistry to assist in diagnosing this treatable neoplasm.     

Actinomycosis as a cause of spinal cord compression: a case report and review

A case is presented of a 40-year-old man with rapidly progressing symptoms of thoracic medullary compression, initially thought to be caused by metastatic pulmonary malignancy. Further investigations, however, revealed thoracic actinomycosis spreading to the vertebral column and an actinomycotic epidural granuloma was causing medullary compression. After decompression by laminectomy and antibiotic treatment with penicillin there was some neurological improvement. The condition is rare, and some of the diagnostic difficulties are discussed.     

Surgical decompression for recurrent cord compression in cancer: a case series and review of the literature

Spine metastases affect a significant number of cancer patients each year, with the spine being the third most common location for cancer spread. As patients live longer with improved treatments, the opportunity for recurrence at previously treated sites increases. Here, we describe seven patients with recurrent, compressive, metastatic spine tumors at previously surgically treated sites that required additional surgical intervention with manipulation of at least one rod. Five of the patients had recurrence including adjacent levels while two had recurrence solely at the previously decompressed level. The patients remained ambulatory for an average of 31.2 months after the initial surgery. We also discuss the role of adjuvant treatment in these patients and review the literature.     

Multilevel thoracic hemangioma with spinal cord compression in a pediatric patient: case report and review of the literature

Purpose

Vertebral hemangiomas are common benign vascular tumors of the spine. It is very rare for these lesions to symptomatically compress neural elements. If spinal cord compression does occur, it usually involves only a single level. Multilevel vertebral hemangiomas causing symptomatic spinal cord compression have never been reported in the pediatric population to the best of our knowledge.

Methods

We report the case of a 15-year-old boy presenting with progressive paraparesis due to thoracic spinal cord compression from a multilevel thoracic hemangioma (T5–T10) with epidural extension.

Results

Because of his progressive neurological deficit, he was initially treated with urgent multilevel decompressive laminectomies from T4 to T11. This was to be followed by radiotherapy for residual tumor, but the patient was unfortunately lost to follow-up. He re-presented 3 years later with recurrent paraparesis and progressive disease. This was treated with urgent radiotherapy with good response. As of 6 months follow-up, he has made an excellent neurological recovery.

Conclusions

In this report, we present the first case of a child with multilevel vertebral hemangiomas causing symptomatic spinal cord compression and review the literature to detail the pathophysiology, management, and treatment of other cases of spinal cord compression by vertebral hemangiomas.     

引起脊髓压迫的脊椎转移瘤的手术治疗体会

目的总结引起脊髓压迫的脊椎转移瘤的临床特点及治疗经验。方法回顾性分析手术治疗的8例引起脊髓压迫的脊椎转移瘤的临床资料。8例病人均行椎板减压及椎管内肿瘤切除术，手术中充分切除椎板，硬膜一般不打开，用取瘤钳咬除侧方及前方的硬膜外肿瘤，使脊髓充分得到减压。对神经根受累或椎体转移灶压迫神经根导致的严重根性疼痛，可切断一侧神经根，术后进行放疗等综合治疗。结果8例均经手术治疗，无手术死亡，随访1—19个月。1例术后4个月因肝癌死亡，其余均存活至今。手术前后神经功能评价采用Frankel分级，术前4例A级的1例无变化，3例恢复到C级；术前2例B级恢复到D级；术前2例C级恢复勉强达E级。所有疼痛均消失，二便功能均有改善。结论部分引起脊髓压迫的脊椎转移瘤经后正中入路肿瘤部分切除、椎板减压治疗可以取得良好的治疗效果。     

Neuroblastoma in an adult causing spinal cord compression: report of a case and review of the literature

Adult neuroblastoma (ANB) is an uncommon malignancy, there being only 42 reported cases in the world literature. The purpose of this report is to present a case of ANB with spinal cord compression by an intraspinal component, and review methods of diagnosis and treatment. NB is one of the most frequent childhood malignancies (90% of the patients are less than 10 years old) and both pathologists and clinicians tend to exclude it from differential diagnosis when the patient is an adult. When the tumour is located in the paraspinal region, local extension through the intervertebral foramen into the spinal canal can occur in a dumbbell fashion, a pattern of growth first described by Weber in 1856.     

Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature

The authors report the case of a 70-year-old woman who developed a Brown–Sequard-syndrome within 6 weeks caused by an intramedullary spinal cord metastasis of an occult renal cell carcinoma. Intramedullary metastases are rare and represent only 4–8.5% of central nervous system metastases. An important feature of intramedullary metastases is the rapid progression of neurological deficits which necessitates rapid treatment. There are only eight earlier reports of intramedullary metastasis due to renal cell carcinoma (Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 1996;47:906–12; Belz P. Ein Fall von intramedullaerer Grawitz-Metastase im Lumbalmark. Frankfurt Z Pathol 1912;10:431–44; Gaylor JB, Howie JW. Brown–Sequard-syndrome. A case of unusual aetiology. J Neurol Neurosurg Psychiatry 1938;1:301–5; Kawakami Y, Mair WGP. Haematomyelia due to secondary renal carcinoma. Acta Neuro Pathol 1973;26:85–92; Strang RR. Metastatic tumor of the cervical spinal cord. Med J Aust 1962;1:205–6; Von Pfungen. Über einige Fälle von Haematomyelie nichttraumatischen Ursprungs. Wien Klin Rdsch 1906;20:44–50; Weitzner S. Coexistent intramedullary metastasis and syringomyelia of cervical spinal cord. Report of a case. Neurology 1960;674–8). To the best of our knowledge this is the first report on a patient in whom symptoms from the metastasis of a renal cell carcinoma preceded the detection of the primary tumor. This report presents the clinical, neuroradiological and histopathological findings of an intramedullary metastasis of a renal cell carcinoma and provides an overview of the literature on intramedullary spinal cord metastases.     

CADASIL with spinal cord involvement: a case report and literature review

Journal of Neurology -     

Intramedullary tuberculoma of the spinal cord: a series of 10 cases

Objective: Involvement of vertebral column is common in tuberculosis but intramedullary tuberculomas are rare. We report a series of ten cases of intramedullary tuberculomas, which, to the best of our knowledge, is the largest series of biopsy proven intramedullary tuberculomas in English literature. Methods: During a period of 16 years (1985–2000), ten cases of intramedullary tuberculomas were diagnosed in our department. Of these, eight cases were histologically proven intramedullary tuberculomas. The clinical profile, radiological data and histological slides were reviewed. Results: Age ranged from 18 to 45 years (mean 29.7 years) and there was slight male preponderance (six men, four women). Duration of symptom varied from 3 to 20 months (mean 11.5 months). All of them presented with motor weakness and sensory impairment. Most common site of involvement was dorsal cord followed by cervical, cervicodorsal and dorsolumbar regions. Three patients had associated involvement of lungs, cervical lymphnodes, and brain, and one patient had past history of tuberculous meningitis. Two patients were treated conservatively but surgical excision was done in eight cases followed by medical treatment. Conclusion: Radiologically, intramedullary tuberculomas should be differentiated from other space occupying lesions (SOL) to avoid unnecessary surgery especially in those patients with tuberculosis of the other organs. The incidence of intramedullary tuberculomas is likely to increase with a rise in the incidence of AIDS.     

Actinomycosis: an unusual cause of spinal cord compression. Case report and review of the literature

Actinomycosis is an unusual and unrecognized cause of spinal cord compression of infectious origin. We report the case of a 57-year-old immunocompetent woman admitted for sub-acute lower limb ataxia. The diagnosis of spinal cord compression secondary to actinomyces infectious arthritis was established. Surgical decompression and long-term antibiotic treatment enabled complete recovery. Data from the literature indicate that actinomycosis is a potential cause of several neurological manifestations. Unusual but treatable, actinomycosis is a potential alternative when the main etiologies have been ruled out.     

Bilateral hemifacial spasm: a series of 10 patients with literature review

Bilateral hemifacial spasm (HFS) is a rare movement disorder posing diagnostic doubt with other facial dyskinesias. In this report, we describe clinical, radiological and therapeutic features of 10 patients with bilateral HFS. The prevalence of bilateral HFS in our sample was of 2.6%. Clinical characteristics of our patients did not differ from the classic features of unilateral cases. The mean latency for contralateral facial nerve involvement was of 33.3 months. In only one case a vascular abnormality was seen. We conclude that bilateral HFS is rare and that clinical differentiation with other facial dyskinesias should be promptly made to introduce appropriate therapy.     

Emergent medical and surgical management of mediastinal infantile hemangioma with symptomatic spinal cord compression: case report and literature review

Purpose

We report an extremely rare case of a patient with a large, cervical, and upper thoracic cutaneous hemangioma associated with a separate, underlying mediastinal hemangioma extending to the epidural space causing significant spinal cord compression.

Case report

A 6-week-old female presented with decreased movement of her right arm and bilateral lower extremity hyperreflexia. Her arm weakness progressed to paralysis over the course of 24 h. She underwent emergent surgical decompression and medical therapy with propranolol and systemic corticosteroids.

Conclusion

While several recent reports have described dramatic responses of hemangiomas to propranolol, this is the first case in which it was used as part of a multimodal approach to symptomatic spinal cord compression. The infant improved immediately after surgery. She is neurologically intact and has radiographic regression of the hemangiomas on follow-up examination 6 months later.     

Intramedullary subependymoma of the spinal cord: a case report and review of literature

A case of cervical spine intramedullary subependymoma in a 52-year-old female is reported. Also, the relevant literature on the 40 cases reported till date is reviewed. Magnetic resonance imaging, even with enhancement, does not show any distinctive features making pre-operative diagnosis often difficult. These tumours are eccentrically located within the spinal cord, thus enabling complete tumour removal in most cases. They are benign with low proliferative potential and hence no post-operative radiotherapy should be administered.     

Cellular and paracellular transplants for spinal cord injury: a review of the literature

Background  

Experimental approaches to limit the spinal cord injury and to promote neurite outgrowth and improved function from a spinal cord injury have exploded in recent decades. Due to the cavitation resulting after a spinal cord injury, newer important treatment strategies have consisted of implanting scaffolds with or without cellular transplants. There are various scaffolds, as well as various different cellular transplants including stem cells at different levels of differentiation, Schwann cells and peripheral nerve implants, that have been reviewed. Also, attention has been given to different re-implantation techniques in avulsion injuries.     

Composite split cord malformation coexisting with spinal cord teratoma--case report and review of the literature

The coincidence of split cord malformation (SCM) and intraspinal teratoma is an extremely uncommon condition. We report a case of a neurologically asymptomatic 13-year-old girl with a 5-year history of progressive scoliosis. The routinely performed MRI revealed SCM at levels L1-L2, tethering of the spinal cord at levels L4-L5 and the presence of an intraspinal tumour at the level of the observed SCM. Intraoperative investigation revealed composite character of SCM. The hemicords were separated by an osseo-cartilaginous septum and contained in a single dural tube. We claim that this is the second described case of a composite SCM and an intraspinal teratoma coexisting at the same level. This case supports the idea that scoliosis may be accompanied by congenital spinal cord anomalies like SCM and intradural tumours. MRI should be the basic diagnostic investigation in such cases. Scoliosis coexisting with SCM and an intradural tumour requires complex neurosurgical and orthopaedic treatment.     

Primary spinal cord oligodendroglioma: case report and review of the literature

Objects The objectives were to present a case of pediatric spinal oligodendroglioma and review the existing literature written in English on the subject of human spinal oligodendrogliomas. A comparison of the clinical, radiologic, and pathologic characteristics, as they relate to those already described in similar cases, was also attempted.Methods Thorough evaluation of the patients clinical course was undertaken. Presenting symptoms and signs are reported. The perioperative radiologic features of the case are presented and the intraoperative details as well as the pathologoanatomic findings and follow-up history are provided. We subsequently performed a thorough search in the literature focusing on the number, characteristics, treatment modalities, and prognosis of patients with spinal cord oligodendrogliomas.Conclusions Spinal oligodendrogliomas are a distinctly rare type of nervous system tumor, especially in the pediatric population. An international registry addressing all of their clinical and pathobiological characteristics would be of great benefit to patients harboring these rare tumors.     

Malignant transformation of a spinal cord ganglioglioma--case report and review of the literature

Gangliogliomas are tumors of mixed glial and neuronal phenotype that usually have a benign clinical course. Rare cases display anaplastic features at the time of first presentation or progress to anaplastic gliomas over extended times. We report on a ganglioglioma of the spinal cord that recurred as a malignant glioma one and a half years after resection. The initial neoplasm was composed of a mixture of well-differentiated ganglionic and astrocytic cells. The recurrent tumor was an anaplastic small-cell glioma. The sole unusual aspect in the initial neoplasm was an abundance of small vessels with calcified walls, which mimicked a vascular malformation.