Neuroblastoma in an adult: Case report / Neuroblastoma en un adulto: Informe de un caso

El neuroblastoma es el tumor maligno sólido extracraneal más común en niños. Sólo el 10 por ciento de los casos se diagnostican después de la primera década de vida. Presentamos una paciente afroamericana de 23 años, con una masa paravertebral en T3-T5, múltiples lesiones en los cuerpos vertebrales y una lesión expansiva en la región parietal derecha. El estudio inmmunohistoquímico (negativo para CD99, CD20, CD3 y desmina y positivo para cromogranina, sinaptofisina y NB84), confirmó el diagnóstico de neuroblastoma. La paciente fue sometida a 12 ciclos de quimioterapia recibiendo VAC (vincristina / doxorubicina/ cyclofosfamida) intercalada con ICE (ifosfamida/ mesna/ etoposido). La doxorubicina fue reemplazada por actinomicina en el séptimo ciclo. La paciente toleró bien la quimioterapia y está clínicamente estable.

Neuroblastoma is the most common extracranial solid malignancy in children but rarely described in adults, being 10 percent of all cases diagnosed after the first decade of life. We report a 23 year-old black woman with a mass at paravertebral region of T3-T5, multiple lesions in vertebral bodies and expanding skull-brain lesion at the right parietal region. Immunohistochemical analysis (negative for CD99, CD20, CD3 and desmin; and positive chromogranin, synaptophysin and NB84) confi rmed the diagnosis of neuroblastoma. The patient was submitted to 12 cycles of chemotherapy receiving VAC (vincristine/doxorubicin/cyclophosphamide) interspersed with ICE (ifosfamide/mesna/etoposide) and doxorubicin was replaced by actinomycin in the 7th cycle. She had good tolerance to this therapy, and has been clinically stable.

Cases of glioblastoma multiforme metastasizing to spinal cord.

Cases of glioblastoma multiforme (GBM) metastasizing to the leptomeninx or the intramedullary spine are quite rare and prognoses are relatively poor. We present three cases of GBM with spinal metastasis, one of which also had leptomeningeal dissemination. Three patients with GBM were admitted to our clinic for postoperative radiotherapy after surgery. Leptomeningeal metastasis and dissemination were diagnosed with magnetic resonance imaging. Radiotherapy provided only temporary relief from pain with small improvement in neurological deficit but no survival advantage.

Metástase intramedular de carcinoma da tireóide: relato de caso / Intramedullary spinal cord metastasis from thyorid carcioma: case report

Relata-se um caso de metástase intramedular de neoplasia da glândula tireóide em uma mulher de 70 anos queixando-se há três meses de dor cervical intensa, sem déficit motor focal nem alterações de sensibilidade. Seis meses antes do início dos sintomas, a paciente foi submetida a tireoidectomia total para ressecção de adenocarcinoma tireoideano. Ressonância magnética com contraste gadolíneo mostrou lesão intramedular. Foi realizada ressecção parcial do tumor medular que revelou ao exame anatomopatológico adenocarcinoma metastático. No pós-operatório a paciente desenvolveu monoplegia crural à esquerda.

Craniospinal dissemination of clival chondroid chordoma.

Chondroid chordoma commonly presents as clival osseous and extradural mass. A 15-year-old boy presented with progressive visual deficit, headaches and diplopia since three years. Computed tomography (CT scan) showed a skull base tumour, but was wrongly reported at the time as chronic sphenoidal sinusitis and nasal polyps. In the past three months, he developed dysphagia, urinary retention and constipation. Terminally, he had weakness of all limbs. Fundoscopy showed optic atrophy. Temporal and spatial variation in symptoms led to a clinical diagnosis of multiple sclerosis with optic neuritis. Partial brain autopsy revealed small gelatinous tumour nodules in the subarachnoid space of middle cranial fossa encasing base of brain like arachnoiditis. Tumour deposits extended down into the spinal cord along the subarachnoid space as far as vision allowed. Histopathology and immunohistochemistry confirmed a diagnosis of chondroid chordoma. Awareness of this rare mode of dissemination will avoid misdiagnosis and delay in treatment.

Cerebellar medulloblastoma presenting with skeletal metastasis.

Medulloblastomas are highly malignant brain tumours, but only rarely produce skeletal metastases. No case of medulloblastoma has been documented to have produced skeletal metastases prior to craniotomy or shunt surgery. A 21-year-old male presented with pain in the hip and lower back with difficulty in walking of 3 months' duration. Signs of cerebellar dysfunction were present hence a diagnosis of cerebellar neoplasm or skeletal tuberculosis with cerebellar abscess formation was considered. MRI of brain revealed a lesion in the cerebellum suggestive of medulloblastoma. Bone scan revealed multiple sites of skeletal metastases excluding the lumbar vertebrae. MRI of lumbar spine and hip revealed metastases to all lumbar vertebrae and both hips. Computed tomography-guided biopsy was obtained from the L3 vertebra, which revealed metastatic deposits from medulloblastoma. Cerebrospinal fluid cytology showed the presence of medulloblastoma cells. A final diagnosis of cerebellar medulloblastoma with skeletal metastases was made. He underwent craniotomy and histopathology confirmed medulloblastoma.

Spinal Epidural Metastasis of Cerebral Oligodendroglioma

A 50-year-old male patient with right frontal oligodendroglioma underwent subtotal resection on three separate occasions and, 10 months later, exhibited right frontal oligodendroglioma and extracranial metastasis. Spinal magnetic resonance imaging (MRI) demonstrated the existence of an enhancing mass lesion with evidence of posterior epidural compression at the10th-11th thoracic level, not involving the vertebrae. A bone scan of the spine appeared normal, but showed evidence of hot uptake in the pelvis and femur. This report concerns a patient who developed a fatal and clinically unexplained, pancytopenia 3 months after the removal of a spinal epidural oligodendroglioma. Oligodendroglioma with metastasis outside the central nervous system is extremely rare, and only a few cases have previously been reported. A brief review of the literature with an emphasis on the mechanisms of tumor cell dissemination is presented.

Intradural extramedullary spinal metastasis from an ovarian carcinoma.

Intradural extramedullary metastases from tumours are a rare occurrence, accounting for less than 2 percent of all spinal metastases. We report a patient who presented with progressive paraparesis one and a half years after being operated for an poorly differentiated serous cystadenocarcinoma. Tumour mass decompression was carried out and the intradural tumour metastasis was removed. Histopathology revealed an identical appearance to the original ovarian tumour. This is the first reported case of an intradural extramedullary metastasis from a poorly differentiated serous cystadenocarcinoma of the ovary.

Sintomatología, diagnóstico y resultados del tratamiento de los síndromes agudos de compresión medular / Symptomatology, diagnosis and results of treatment in acute spinal cord compression syndromes

Los síndromes agudos de compresión medular en la gran mayoría de los casos (88 por ciento) se deben a tumores espinales, de los cuales dos tercios corresponden a metástasis. El 76 por ciento de los casos presentan un período prodrómico previo a la aparición de déficit neurológicos, caracterizados por dolores, mientras que sólo pocos casos inician su sintomatología con trastornos de la función motora o sensitiva. Aparte de las radiografías simples de columna y la mielografía, la tomografía computarizada y la resonancia magnética ocupan hoy en día una posición destacada en el diagnóstico de esta enfermedad. Independientemente del hecho si se trata de un tumor primario o una metástasis los resultados operatorios son más favorables en aquellos casos que presentan los menores déficit preoperatorios, lo cual subraya la importancia de una interpretación cuidadosa de los síntomas iniciales

Raras metástasis y evolución en un paciente con neoplasia vesical / Rare metastases and course in a patient with vesical neoplasm

Se presenta un caso clínico de frecuencia poco común. Se trata de un paciente que presenta neoplasia vesical de alto grado de diferenciación, operado y en el que posteriormente se descubren metástasis a nivel de la médula espinal y el cráneo. El paciente evoluciona muy favorablemente sin tratamiento citostático o radioterápico, no presenta recidiva tumoral y se observa disminución de las células metastásicas de la médula espinal. Los resultados son evaluados a los 9 años y 6 meses de operado. Realizamos un breve recordatorio anatomopatológico de la neoplasia vesical