Cases reported "Epidural Neoplasms"

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1/24. Extensive epidural teratoma in early infancy treated by multi-stage surgery.

    We report a rare case of extensive extradural teratoma successfully treated by multi-stage laminotomy and thoracotomy. A 34-day-old, dyspneic infant had a large posterior mediastinal mass identified on a chest X-ray radiograph. Imaging studies disclosed that the mass originated from the extradural space at the level of the lower thoracic spine, extending cephalad to C4 and caudad to L4 and severely compressing the spinal cord anteriorly, causing paraplegia. The tumor expanded bilaterally through the intraspinal foramina, coalescing to form a huge mediastinal mass. The upper half of the teratoma was removed utilizing a laminotomy from T3 through T9; 2 months later the lower half was excised via a laminotomy from T11 to L3. An additional procedure was required to resect recurrent tumor through a laminotomy from T8 to T12. The reconstructed vertebral arches were well-preserved in shape, with an almost normal spinal canal.
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2/24. Epidural compression of the cauda equina caused by vertebral osteoblastic metastasis of prostatic carcinoma: resolution by hormonal therapy.

    A 59 year old man with prostatic carcinoma developed epidural compression of the cauda equina caused by bony expansion from a vertebral osteoblastic metastasis. For medical reasons he could not undergo radiation or surgery. Hormonal therapy alone relieved his low back pain and restored ambulation and urinary function. Postmyelography CT showed that the bony expansion from the vertebra had completely disappeared after treatment. This is the first report of remarkable improvement due to hormonal therapy alone.
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keywords = back pain, back
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3/24. Primary spinal epidural extraosseous Ewing's sarcoma: report of five cases and literature review.

    Ewing's sarcoma is the most common malignant bone tumour occurring in children and adolescents and exists in two different clinicopathological entities: osseous Ewing's sarcoma (OES) and extraosseous Ewing's sarcoma (EES). Five cases of primary epidural EES are described, which presented with non-specific symptoms leading to a long diagnostic delay. The median age at diagnosis was 22 years (range 13-36 years). The median diagnostic delay was 3 months. All patients had one or more neurological deficits. All underwent surgical exploration with a laminectomy and partial resection followed by adjuvant radiotherapy to a dose of 46-50 Gy and chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) alternating with ice (ifosphamide, cisplatin and etoposide) for at least six cycles. The mean follow-up period is 21.2 months (range 11-32 months). Four of the five patients achieved a complete remission and are disease free at the time of writing this report. Two patients have a residual neurological deficit--both having presented with long history of neurological deficit. Primary spinal epidural EES should be suspected whenever young patients present with back pain and/or radicular pain, have abnormal neurology and an extradural mass is demonstrated on MRI. Surgical excision followed by adjuvant radiotherapy (50 Gy) and combination chemotherapy (VAC alternating with ice) achieved local and systemic control in these patients. A greater number of patients and longer follow up are required to evolve a generally accepted treatment policy for this aggressive but potentially curable malignancy.
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ranking = 511.94191820084
keywords = back pain, back
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4/24. Primary spinal epidural non-Hodgkin's lymphoma in a child.

    Non-Hodgkin's lymphoma usually involves the central nervous system by metastatic disease. Primary spinal epidural non-Hodgkin's lymphoma (PSENL) is a relatively rare cause of spinal cord compression. It mainly occurs in adults past the 4th or 5th decades. This entity is even rarer in children. The proper treatment modalities are controversial in adults with PSENL. radiotherapy is the main strategy after surgery; the role of chemotherapy is uncertain. Therapeutic experience in childhood PSENL is extremely limited. We report a 10-year-old boy presenting with backache and bilateral lower leg weakness after minor trauma. Small non-cleaved cell non-Hodgkin's lymphoma of the epidural space was proven after subtotal tumor removal. Other investigations including computed tomography of the chest and abdomen, bone scan, gallium scan, bone marrow aspiration, and cerebrospinal fluid study were all negative for occult disease. The patient received combined therapy with irradiation and chemotherapy after surgery. Esophageal stricture resulting from radiotherapy developed during treatment and colon interposition was performed. He has remained disease free 42 months after the diagnosis with normal functional status.
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keywords = back
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5/24. Spinal extradural angiolipoma, with a literature review.

    INTRODUCTION: angiolipoma is a benign tumour composed of mature adipocytes admixed with abnormal vascular elements. It reportedly accounts for 0.1-0.5% of all spinal axis tumours in adults and is extremely rare in children. CASE REPORT: This article describes a case of thoracic spinal angiolipoma in a 4-year-old boy, who presented with back pain and weakness. The tumour was excised, and the child made a remarkable recovery. DISCUSSION: Only five previous cases of extradural angiolipoma have been reported in children. The authors review the existing literature on the aetiology, pathogenesis, and clinical pathology, and the surgical management is discussed.
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ranking = 511.94191820084
keywords = back pain, back
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6/24. cauda equina compression after trauma: an unusual presentation of spinal epidural lipoma.

    STUDY DESIGN: A case report is presented. OBJECTIVE: To describe a case of a spinal epidural lipoma presenting as a cauda equina compression syndrome secondary to trauma. SUMMARY OF BACKGROUND DATA: Epidural lipomas are rare lesions that present as back pain with progressive neurologic symptoms. methods: A patient presenting with cauda equina compression after an injury was investigated and treated surgically. The clinical follow-up period was 3 years. RESULTS: Imaging of the lumbar spine showed an extradural mass compressing the cauda equina. The patient underwent emergency surgery, and an adipose mass was removed. Neurologic recovery was observed and maintained 3 years after surgery. CONCLUSIONS: Previously asymptomatic epidural masses such as lipomas can present with neurologic deficit after trauma. Appropriate imaging can help in the diagnosis and management of such cases.
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ranking = 511.94191820084
keywords = back pain, back
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7/24. Chiari I malformation associated with thoracic epidural cord lesion: case report.

    Many spinal cord lesions have been described previously, in association with Chiari I lesions. The authors report a unique case of a 29-year-old patient with a Chiari I malformation and an upper thoracic epidural lesion causing headaches, dysphagia and brown-sequard syndrome. The patient underwent a suboccipital decompression as well as a thoracic laminectomy and resection of the epidural lesion. Pathologic analysis revealed that the thoracic lesion was fibro-adipose tissue. A review of the literature failed to show any other similar cases. We discuss the possible etiologies of this case.
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8/24. Primary spinal epidural non-Hodgkin's lymphoma. The contribution of nuclear magnetic resonance imaging, therapeutic approach and review of the literature.

    Primary spinal epidural lymphoma (Stage I) is diagnosed predominantly late after a long prodromal phase of local back pain resulting in spinal cord compression. The use of CT and NMR images in the early stage of investigation and their analysis may help to diagnose these cases prior to the appearance of neurologic deficit. We report on 2 patients who presented with prolonged localized back pain with sudden symptoms of spinal cord compression. CAT scan and NMR imaging demonstrated the characteristic appearance of lymphoma. Decompressive laminectomy supported the diagnosis. radiotherapy treatment to the region of the non-Hodgkin's lymphoma resulted in complete resolution. Thereafter, systemic chemotherapy with CHOP achieved a good response.
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ranking = 1023.8838364017
keywords = back pain, back
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9/24. Idiopathic epidural lipomatosis as a cause of pain and neurological symptoms attributed initially to radiation damage.

    Epidural lipomatosis is a rare condition in which overgrowth of extradural fat can lead to back pain, spinal cord compression and radiculopathy. A 51-year-old man developed back pain and reduced mobility following a standard course of radiotherapy for a Stage I seminoma. His symptoms and radiological appearances were initially attributed to radiation fibrosis. Further investigations and operative intervention revealed epidural lipomatosis. The excess lipomatous tissue was removed with complete resolution of his symptoms.
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keywords = back pain, back
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10/24. Spinal epidural rhabdomyosarcoma.

    We report an extremely rare case of rhabdomyosarcoma in the lower cervical and upper thoracic spine. The MR imaging appearance of the lesion was nonspecific, and different from the one previously reported. The majority of the tumor was removed surgically less than a month from the onset of symptoms. Treatment was continued with spinal irradiation and chemotherapy, however diffuse leptomeningeal metastases were found six months later.
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