Spinal cord compressions secondary to epidural metastases

Case contributed by Dr Zaid Omari

Presentation

Patient with known history of pelvic bone Ewing sarcoma, presented with loss of sensation below the nipple line with loss of power in both lower limbs and urinary retention.

Patient Data

Age: 25 years
Gender: Male

There are two extradural soft tissue masses, as follows : 

  • one seen at the level D3-D4 causing severe compression on the right posterolateral spinal cord, displacing the spinal cord anterolaterally to the left side, protruding through the right nerve foramina
  • the other one is seen at the level D8 causing compression on the right posterolateral spinal cord and displacing the spinal cord anterolaterally to the left side, and protruding through the right nerve foramina

There are diffuse osseous lesions in the spine, that appear low intense on T1-weighted images and hyperintense on T2 weighted images, consistent with osseous metastases.
The one which is seen at the level of D11 is associated with surrounding left paravertebral and extradural soft tissue components indenting the anterior lateral aspect of the spinal cord.
There is a small intradural soft tissue metastatic nodule in the thecal sac posteriorly at the level of the D12 vertebral body.
The urinary bladder is overfilled, secondary to urinary retention.

Case Discussion

The patient underwent radiotherapy and decompression surgery, his condition improved post-surgery. The Pathology confirmed metastases from the known pelvis Ewing sarcoma

This is the pathology report: Diagnosis: T8 soft tissue mass; Biopsy: consistent with metastatic Ewing sarcoma. Note: The tumor cells are positive for CD99 and NKX2.2.  

Spinal cord compression could be divided according to the location into epidural, dural, and intradural causes as follows:

  • epidural lesions: epidural abscess or phlegmon, epidural hematoma and metastases
  • dural lesions: epinal meningioma and spinal arachnoid cyst
  • intradural lesions: nerve sheath tumor (spinal schwannoma or neurofibroma)

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