scholarly journals Chondrosarcoma Arising from the Posterior Iliac Crest Extending into the Spinal Canal

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Kota Wada ◽  
Akio Sakamoto ◽  
Rei Kato ◽  
Takashi Noguchi ◽  
Takayoshi Shimizu ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Iliac Crest ◽  
Cauda Equina ◽  
Low Grade ◽  
Tumor Type ◽  
Tumor Extension ◽  
Neurogenic Tumors ◽  
Posterior Extension ◽  
Matrix Extension ◽  
Intraspinal Extension

Chondrosarcoma is a malignant tumor characterized by the production of a cartilage matrix. Extension into the spinal canal from the extracannular space is seen mainly for neurogenic tumors, but it is rare in nonneurogenic tumors. A 75-year-old woman suffered from sciatic pain and numbness in her lower left extremity. The diagnosis was of a low-grade conventional chondrosarcoma, which originated from the posterior ilium with an intraspinal extension at the level of the sacrum, compressing the cauda equina. The tumor extended further into the S1 sacral anterior foramen, in the shape of a dumbbell. The tumor was resected in several blocks posteriorly, and the dumbbell-shaped tumor in the S1 foramen was resected by widening the S1 foramen from behind. The posterior extension of the iliac tumor seemed prevented by the posterior sacroiliac ligament, and the tumor extended into the canal. Here, we report that the iliac chondrosarcoma extending into the spinal canal is rare for this tumor type. An understating of the tumor extension is important for planning the surgical strategy.

Perineural spread of peripheral neurolymphomatosis to the cauda equina

2021 ◽  
pp. 1-6
Author(s):  
Nikhil K. Murthy ◽  
Kimberly K. Amrami ◽  
Stephen M. Broski ◽  
Patrick B. Johnston ◽  
Robert J. Spinner
Keyword(s):  
B Cell ◽  
Tumor Cells ◽  
Spinal Canal ◽  
Cell Lymphoma ◽  
Cauda Equina ◽  
B Cell Lymphoma ◽  
Spinal Nerve ◽  
Low Grade ◽  
Lumbosacral Plexus ◽  
Perineural Spread

OBJECTIVE Neurolymphomatosis (NL) is a rare manifestation of lymphoma confined to the peripheral nervous system that is poorly understood. It can be found in the cauda equina, but extraspinal disease can be underappreciated. The authors describe how extraspinal NL progresses to the cauda equina by perineural spread and the implications of this on timely and safe diagnostic options. METHODS The authors used the Mayo Clinic medical records database to find cases of cauda equina NL with sufficient imaging to characterize the lumbosacral plexus diagnosed from tissue biopsy. Demographics (sex, age), clinical data (initial symptoms, cerebrospinal fluid, evidence of CNS involvement, biopsy location, primary or secondary disease), and imaging findings were reviewed. RESULTS Ten patients met inclusion and exclusion criteria, and only 2 of 10 patients presented with cauda equina symptoms at the time of biopsy, with 1 patient undergoing a cauda equina biopsy. Eight patients were diagnosed with diffuse large B-cell lymphoma, 1 with low-grade B-cell lymphoma, and 1 with mantle cell lymphoma. Isolated spinal nerve involvement was identified in 5 of 10 cases, providing compelling evidence regarding the pathophysiology of NL. The conus medullaris was not radiologically involved in any case. Lumbosacral plexus MRI was able to identify extraspinal disease and offered diagnostically useful biopsy targets. FDG PET/CT was relatively insensitive for detecting disease in the cauda equina but was helpful in identifying extraspinal NL. CONCLUSIONS The authors propose that perineural spread of extraspinal NL to infiltrate the cauda equina occurs in two phases. 1) There is proximal and distal spread along a peripheral nerve, with eventual spread to anatomically connected nerves via junction and branch points. 2) The tumor cells enter the spinal canal through corresponding neural foramina and propagate along the spinal nerves composing the cauda equina. To diffusely infiltrate the cauda equina, a third phase occurs in which tumor cells can spread circumdurally to the opposite side of the spinal canal and enter contralateral nerve roots extending proximally and distally. This spread of disease can lead to diffuse bilateral spinal nerve disease without diffuse leptomeningeal spread. Recognition of this phasic mechanism can lead to identification of safer extraspinal biopsy targets that could allow for greater functional recovery after appropriate treatment.

scholarly journals QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii438-iii438
Author(s):  
Kathleen Dorris ◽  
Jessica Channell ◽  
Ashley Mettetal ◽  
Molly Hemenway ◽  
Natalie Briones ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Cell Activity ◽  
Cns Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Central Nervous System Tumor ◽  
The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

scholarly journals EPID-13. A POPULATION-BASED ANALYSIS OF CNS TUMOR DIAGNOSES, TREATMENT, AND SURVIVAL IN CONGENITAL AND INFANT AGE GROUPS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii321-iii321
Author(s):  
Muriel Hart ◽  
Amy Mellies ◽  
Alina Beltrami ◽  
Ahmed Gilani ◽  
Adam Green
Keyword(s):  
Age Groups ◽  
Young Patients ◽  
High Grade Glioma ◽  
Population Based ◽  
Cns Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Older Children ◽  
Embryonal Tumors ◽  
Chi Square

Abstract BACKGROUND Congenital (<3 months) and infant (3 to 11 months) brain tumors are biologically different from tumors in older children, but epidemiology of these tumors has not been studied comprehensively. Insight into epidemiological differences could help tailor treatment recommendations by age and increase overall survival (OS). METHODS Population-based data from the SEER 18 registries was obtained for 14,493 0-19-year-olds diagnosed with CNS tumors between 1990 and 2015. Incidence, treatment, and survival were analyzed using Chi-square and Kaplan-Meier analyses. RESULTS Between the <3 month, 3–5 month, 6–11 month, and 1–19 year age groups, tumor type distribution differed significantly (p<0.001); high-grade glioma (HGG) was most common in the <3-month-olds, while low-grade glioma (LGG) was most common in the other groups. 5-year OS for all tumors was 36.7% (<3 months), 56.0% (<3–5 months), 63.8% (6–11 months), and 74.7% (1–19 years) (log rank p<0.001). OS by tumor type was worst for <3-month-olds with LGG, medulloblastoma, and other embryonal tumors; OS was worst for 3-5-month-olds with ependymoma, <1-year-olds collectively with atypical teratoid-rhabdoid tumor, and 1-19-year-olds with HGG (log rank p<0.02 for all tumor types). <3-month-olds were least likely to receive any treatment for each tumor type and least likely to undergo surgery for all except HGG. <1-year-olds were far less likely than 1-19-year-olds to undergo radiation for embryonal tumors, as expected, but were also less likely to undergo chemotherapy. CONCLUSIONS Congenital/infant CNS tumors differ pathologically, therapeutically, and prognostically from those in older children. Treatment changes could help address poorer outcomes for these young patients.

Radiation necrosis or glioma recurrence: is computer-assisted stereotactic biopsy useful?

1995 ◽  
Vol 82 (3) ◽  
pp. 436-444 ◽  
Author(s):  
Peter A. Forsyth ◽  
Patrick J. Kelly ◽  
Terrence L. Cascino ◽  
Bernd W. Scheithauer ◽  
Edward G. Shaw ◽  
...  
Keyword(s):  
Disease Progression ◽  
Tumor Recurrence ◽  
Stereotactic Biopsy ◽  
Radiation Necrosis ◽  
Low Grade ◽  
Tumor Type ◽  
Content Type ◽  
Radiation Induced ◽  
Chondroblastic Osteosarcoma ◽  
Fine Print

✓ Fifty-one patients with supratentorial glioma treated with external beam radiotherapy (median dose 59.5 Gy) who then demonstrated clinical or radiographic evidence of disease progression underwent stereotactic biopsy to differentiate tumor recurrence from radiation necrosis. The original tumor histological type was diffuse or fibrillary astrocytoma in 21 patients (41%), oligodendroglioma in 13 (26%), and oligoastrocytoma in 17 (33%); 40 tumors (78%) were low-grade (Kernohan Grade 1 or 2). The median time to suspected disease progression was 28 months. Stereotactic biopsy showed tumor recurrence in 30 patients (59%), radiation necrosis in three (6%), and a mixture of both in 17 (33%); one patient (2%) had a parenchymal radiation-induced chondroblastic osteosarcoma. The tumor type at stereotactic biopsy was similar to the original tumor type and was astrocytoma in 24 patients (47%), oligodendroglioma in eight (16%), oligoastrocytoma in 16 (31%), unclassifiable in two (4%), and chondroblastic osteosarcoma in one patient (2%). At biopsy, however, only 19 tumors (37%) were low grade (Kernohan Grade 1 or 2). Subsequent surgery confirmed the stereotactic biopsy histological findings in eight patients. Follow-up examination showed 14 patients alive with a median survival of 1 year for the entire group. Median survival times after biopsy were 0.83 year for patients with tumor recurrence and 1.86 years for patients with both tumor recurrence and radionecrosis; these findings were significantly different (p = 0.008, log-rank test). No patient with radiation necrosis alone died. Other factors associated with reduced survival were a high proportion of residual tumor (p = 0.024), a low proportion of radionecrosis (p < 0.001), and a Kernohan Grade of × or 4 (p = 0.005). In conclusion, in patients with previously irradiated supratentorial gliomas in whom radionecrosis or tumor recurrence was clinically or radiographically suspected, results of stereotactic biopsy could be used to differentiate tumor recurrence, radiation necrosis, a mixture of both lesions, or radiation-induced neoplasm. In addition, biopsy results could predict survival rates.

scholarly journals Fascia lata attachment at the iliac crest: refining our diagnostic criteria of injury on magnetic resonance imaging

2020 ◽  
Vol 93 (1111) ◽  
pp. 20200187
Author(s):  
Ali Serhal ◽  
Bradley Adams ◽  
Imarn Omar ◽  
Swati Deshmukh
Keyword(s):  
Diagnostic Criteria ◽  
Iliac Crest ◽  
Fascia Lata ◽  
Hip Pain ◽  
Large Field ◽  
Low Grade ◽  
Total N ◽  
Anatomic Structure ◽  
Pelvic Mri ◽  
Asymptomatic Patients

Objective: The objective of this study was to determine the prevalence and spectrum of pathology of the fascia lata attachment at the iliac crest (FLAIC) on MRI in asymptomatic patients in order to refine our diagnostic criteria for clinically relevant FLAIC injury. Methods and material: Two readers retrospectively evaluated the FLAIC on each side on coronal large field-of-view short tau inversion recovery images on 100 musculoskeletal pelvic MRI exams performed in patients without hip pain (total n = 200). Pathology of the FLAIC was graded using a 3-point Likert scale and discrepancies were resolved by consensus. Results: Of the 200 FLAIC included in the study, 72.5% demonstrated normal size and signal intensity. Low to moderate grade pathology of the FLAIC was identified in 27% and high-grade partial thickness pathology was seen in 0.5%. No cases of complete FLAIC rupture were identified. Inter rater agreement between the two readers was good (k=0.660, p < 0.001). There was no statistical difference in FLAIC scores according to gender or age. FLAIC score was positively correlated with higher body mass index. Conclusion: Incidental low to moderate grade FLAIC pathology is commonly seen on MRI in asymptomatic patients. Abnormal MRI findings of the FLAIC should hence be correlated with explicit clinical symptoms and physical exam findings. Advances in knowledge: The Fascia lata is a complex anatomic structure. Its attachment to the iliac crest is an under recognized pathology and sometimes overlooked during evaluation for pelvis and lateral hip pain. Evaluation of the FLAIC is easily done with MRI and abnormality should be correlated to the clinical symptomatology as low grade abnormality is frequently seen in asymptomatic population.

scholarly journals Cerebrospinal Fluid MicroRNA Signatures as Diagnostic Biomarkers in Brain Tumors

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1546 ◽  
Author(s):  
Alena Kopkova ◽  
Jiri Sana ◽  
Tana Machackova ◽  
Marek Vecera ◽  
Lenka Radova ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Tumor Patients ◽  
Primary Tumors ◽  
Mirna Profiling ◽  
Tumor Types ◽  
Cns Malignancies

Central nervous system (CNS) malignancies include primary tumors that originate within the CNS as well as secondary tumors that develop as a result of metastatic spread. Circulating microRNAs (miRNAs) were found in almost all human body fluids including cerebrospinal fluid (CSF), and they seem to be highly stable and resistant to even extreme conditions. The overall aim of our study was to identify specific CSF miRNA patterns that could differentiate among brain tumors. These new biomarkers could potentially aid borderline or uncertain imaging results onto diagnosis of CNS malignancies, avoiding most invasive procedures such as stereotactic biopsy or biopsy. In total, 175 brain tumor patients (glioblastomas, low-grade gliomas, meningiomas and brain metastases), and 40 non-tumor patients with hydrocephalus as controls were included in this prospective monocentric study. Firstly, we performed high-throughput miRNA profiling (Illumina small RNA sequencing) on a discovery cohort of 70 patients and 19 controls and identified specific miRNA signatures of all brain tumor types tested. Secondly, validation of 9 candidate miRNAs was carried out on an independent cohort of 105 brain tumor patients and 21 controls using qRT-PCR. Based on the successful results of validation and various combination patterns of only 5 miRNA levels (miR-30e, miR-140, let-7b, mR-10a and miR-21-3p) we proposed CSF-diagnostic scores for each tumor type which enabled to distinguish them from healthy donors and other tumor types tested. In addition to this primary diagnostic tool, we described the prognostic potential of the combination of miR-10b and miR-196b levels in CSF of glioblastoma patients. In conclusion, we performed the largest study so far focused on CSF miRNA profiling in patients with brain tumors, and we believe that this new class of biomarkers have a strong potential as a diagnostic and prognostic tool in these patients.

Low-grade small round cell tumor of the cauda equina with EWSR1-WT1 fusion and indolent clinical course

2015 ◽  
Vol 46 (1) ◽  
pp. 153-158 ◽  
Author(s):  
Nasir Ud Din ◽  
Melike Pekmezci ◽  
Gohar Javed ◽  
Andrew E. Horvai ◽  
Zubair Ahmad ◽  
...  
Keyword(s):  
Clinical Course ◽  
Cauda Equina ◽  
Cell Tumor ◽  
Low Grade ◽  
Round Cell ◽  
Round Cell Tumor ◽  
Small Round Cell Tumor ◽  
Small Round Cell

scholarly journals Thoracoscopic surgical resection of thoracic neurogenic tumors

1999 ◽  
Vol 7 (5) ◽  
pp. E3 ◽  
Author(s):  
Patrick P. Han ◽  
Curtis A. Dickman
Keyword(s):  
Tumor Resection ◽  
Open Thoracotomy ◽  
Total Resection ◽  
Thoracic Sympathectomy ◽  
Neurogenic Tumors ◽  
Normal Tissues ◽  
Intercostal Neuralgia ◽  
The Mean ◽  
Intraspinal Extension

Five patients who harbored large intrathoracic paraspinal neurogenic tumors were treated using thoracoscopic techniques to achieve gross-total tumor resection. All tumors were entirely intrathoracic except one that had an intraspinal extension, and all tumors were treated entirely thoracoscopically except for this one. Gross-total resection was achieved in all cases. The mean clinical follow-up period was 6.8 months. Postoperatively, one patient developed Horner's syndrome. The only other complication was transient intercostal neuralgia (two patients), which has resolved in both patient. No evidence of disease was demonstrated clinically or on follow-up imaging in any patient. Thoracoscopy is an excellent modality with which to treat these tumors, in part because it is associated with significantly less morbidity than open thoracotomy and costotransversectomy procedures. Endoscopic transthoracic approaches reduce the approach-related soft-tissue morbidity by preserving the normal tissues of the chest wall, avoiding rib retraction and muscle transection, reducing postoperative pain, and facilitating recovery. This technique has become the senior author's (C.A.D.'s) surgical approach of choice for the removal of intrathoracic benign paraspinal neurogenic tumors. It has also become the preferred method by which to perform thoracic sympathectomy and remove central, herniated thoracic discs.

Spinal meningiomas: Clinical and therapeutic tonsiderations

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 322-326
Author(s):  
Johannes Schröder ◽  
Bernhard Fischer ◽  
Stefan Palkovic ◽  
Hansdetlef Wassmann
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Complete Removal ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Before And After ◽  
Patient Will ◽  
Spinal Meningiomas ◽  
The Mean

AbstractMeningiomas of the spinal canal are rare, in contrast to their cranial counterparts. This study reports on the dominant features of spinal meningiomas before and after treatment. We treated 30 patients (23 female) with meningiomas of the spinal canal from 1992 to 2003. The mean age was 68 (range: 43–91). Upon admission, 26 patients presented with a marked neurological deficit (11 paraparesis, 9 motor weakness, 4 myelopathic ataxia, 1 quadriplegia, and 1 cauda equina syndrome). Two patients had sensory deficits, and two had pain only. The distribution of the tumors was as follows: 8 cases were cranio-cervical, 1 case was cervical, 6 cases were at the cervico-thoracic junction, 9 cases were of the thoracic spine, 5 cases were of the thoracolumbar spine, and 1 case was of the lumbar spine. Five cases also had intracranial manifestations. The mean interval between the onset of the first symptoms and treatment was 12 months. All cases were treated via (hemi)-laminectomy for complete removal of the tumor and occasionally via duraplasty. After a mean follow-up of 3 years, symptoms had improved by 3 points (on a 5-point scale) in 3 cases, by 2 points in 7 cases, and by 1 point in 12 cases; 7 cases were unchanged, and 1 case had worsened by 1 point. We observed 3 local recurrences. One case developed manifestations at a different site. Spinal meningiomas are often diagnosed late, after they have already caused major neurological deficits. Nevertheless, owing to their benign character, the outcome is favorable when treated appropriately. The outcome depends above all on the initial neurological status. The worse the deficit is, the less probable it is that the patient will recover neurologically.

Radiographic and clinical factors associated with improved outcomes in cancer patients with bowel obstruction

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20564-e20564
Author(s):  
C. M. Contreras ◽  
B. D. Badgwell ◽  
R. L. Askew ◽  
B. W. Feig ◽  
J. N. Cormier
Keyword(s):  
Serum Albumin ◽  
Peritoneal Carcinomatosis ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Bowel Obstruction ◽  
Enteral Feeding ◽  
Primary Diagnosis ◽  
Low Grade ◽  
Tumor Type ◽  
Clinical Factors

e20564 Background: The purpose of this study was to identify clinical and radiographic factors relevant to treatment outcomes in cancer patients presenting with bowel obstruction. Methods: Clinical and radiographic factors were retrospectively abstracted from records of inpatients referred for surgical consultation for suspected bowel obstruction (2000–2006). Patients were stratified by treatment: surgical treatment (ST), minimally invasive (percutaneous/endoscopic) procedures (MIP), or bowel rest (BR). Clinical outcomes such as status at discharge and median overall survival (OS) were examined. Results: Of 194 patients, 25% had a primary diagnosis of colorectal cancer. Computed tomography, plain radiographs, enteral contrast studies, and other modalities were used for diagnosis in 59%, 26%, 12%, and 3% of patients, respectively. 62% of obstructions were located in the small bowel, with the remaining 23% and 12% identified as gastric outlet and colon, respectively. Over 90% of patients treated with ST (n = 60) were discharged home and tolerated enteral feeding. In contrast, for patients treated with MIP and BR, 48% and 68% were discharged home, and 70% and 72% were able to tolerate enteral feeding, respectively. OS was similar for patients treated with ST (6.3 months) and for those whose bowel obstruction resolved with BR (6.4 months). For patients treated with MIP, however, OS was 1.4 months. Though significant differences in OS for patients treated with ST and MIP were observed (p<0.0001), 30-day readmission rates were similar across treatment groups. Radiographic images demonstrating low grade obstruction, absence of ascites, and the absence of peritoneal carcinomatosis were associated with improved OS. Additional relevant clinical factors affecting OS included serum albumin level; however, no association was observed for age, tumor type, site of obstruction, previous bowel obstruction, or abdominal exploration. Conclusions: Clinical and radiographic factors affect treatment outcomes for cancer patients with bowel obstruction. Given that factors such as ascites, peritoneal carcinomatosis and low serum albumin result in poor OS, non-invasive procedures should be considered. No significant financial relationships to disclose.

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