Single Stage Combined Approach Sagittal En-Block Spondylectomy for L3 Vertebral Chondrosarcoma: A Technical Note.

BACKGROUND: Primary malignant tumors of the spine are rare which most commonly occur in lumbar and thoracic vertebra. Here, we report a rare case of retroperitoneal chondrosarcoma of the L3 vertebra which was managed with sagittal en-block spondylectomy following chemoradiation. CASE PRESENTATION: A 26-year-old lady was evaluated for abdominal pain with contrast enhanced computer tomogram of abdomen and pelvis which revealed a soft tissue retroperitoneal mass arising from L3 vertebra. She underwent laparotomy and biopsy which revealed chondrosarcoma and she received chemoradiation over a period of 28 weeks, 6 days. After re-imaging she underwent single stage combined approach sagittal en-block spondylectomy of retroperitoneal chondrosarcoma of L3 vertebra with right nephrectomy and spine reconstruction. She was followed for a period of 3 years, there was no evidence of recurrence in follow-up CECT abdomen and pelvis. She has no gait abnormality or spinal deformity. CONCLUSION: Sagittal en-block spondylectomy is a preferred surgical approach for eccentrically placed spinal tumors which offers better oncological and functional outcomes.

Aggressive Brainstem Glioblastoma in a 9-Year-Old Child with Neck Node Metastases: A Case Report and Review of Literature.

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and diffusely infiltrates the surrounding brain tissue. Despite their malignant nature, extraneural metastases from glioblastomas are rare with an estimated incidence of <2%. We present a case of a 9-year-old boy with exophytic brainstem GBM who developed cervical node metastases. He had undergone gross total excision of GBM in January 2017. Histopathological examination confirmed the diagnosis of glioblastoma multiforme. The patient underwent chemotherapy and radiotherapy as per hospital protocol. He developed hydrocephalus after 3 months, which required ventriculoperitoneal shunt. Two more months later, he developed drowsiness and was found to have shunt dysfunction causing hydrocephalus and multiple enlarged cervical lymph nodes. Cerebrospinal fluid diversion and neck node biopsy were performed for the patient but he died. The histopathological examination of the neck node biopsy revealed metastases from glioblastoma. We report this case to create awareness regarding possibility of extraneural metastases even in pediatric brainstem glioblastoma.