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Successful chemotherapeutic decompression of primary endodermal sinus tumor presenting with severe spinal cord
F D Pashankar1, P Steinbok, G Blair
1Division of Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada.
Insights
Cisplatin-based chemotherapy effectively treated spinal cord compression from endodermal sinus tumors (EST) in a child. This approach led to rapid symptom resolution and full neurologic recovery without surgery or radiation.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Medical Imaging
Background:
- Spinal cord compression in children can result from various tumors.
- Primary paraspinal endodermal sinus tumors (EST) are rare but aggressive pediatric malignancies.
- Management often involves a multimodal approach including surgery, radiation, and chemotherapy.
Observation:
- A 17-month-old child presented with near-complete paraplegia due to a primary paraspinal EST causing spinal cord compression.
- The tumor was compressing the spinal cord, leading to severe neurological deficits.
Findings:
- The child received cisplatin-based chemotherapy as the primary treatment modality.
- Laminectomy and radiation therapy were deliberately avoided.
- Rapid resolution of paraplegia and complete neurologic recovery were observed.
- Excellent tumor response to chemotherapy was achieved with no long-term sequelae.
Implications:
- Chemotherapy alone can be a viable and effective alternative to laminectomy or radiation therapy for managing epidural spinal cord compression caused by EST.
- This non-invasive approach offers a promising treatment strategy for pediatric patients with spinal cord compression from EST, potentially reducing treatment-related morbidity.
- Further research into chemotherapy-alone protocols for similar cases is warranted to establish its efficacy and safety profile.
Abstract:
Management of spinal cord compression from a primary paraspinal endodermal sinus tumor (EST) is described. A 17-month-old child presented for treatment with near-complete paraplegia secondary to spinal cord compression from a primary paraspinal EST. The child was treated with cisplatin-based chemotherapy without laminectomy or radiation therapy. Rapid resolution of symptoms was observed. The child had an excellent tumor response and complete neurologic recovery with no sequelae. Chemotherapy alone is an alternative to laminectomy or radiation therapy in the management of epidural cord compression from EST, even when the cord compression is severe.