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Calibrated Forceps Model of Spinal Cord Compression Injury
Published on: April 24, 2015
Spinal cord compression in children with Wilms' tumour
P K Ramdial1, G P Hadley, Y Sing
1Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, National Health Laboratory Service, Durban, South Africa.
Insights
Wilms' tumour (WT) rarely causes paraplegia in children. In developing countries, late presentation leads to poor outcomes, but surgery may relieve symptoms and provide biopsies for this rare pediatric cancer.
Area of Science:
- Pediatric Oncology
- Nephrology
- Neurology
Background:
- Wilms' tumour (WT) is a rare pediatric kidney cancer.
- Spinal involvement with WT can lead to significant neurological deficits, including paraplegia.
- Outcomes for WT with spinal disease are often poor, especially in resource-limited settings.
Purpose of the Study:
- To describe the clinical, imaging, and histopathological characteristics of children with paraplegia secondary to Wilms' tumour.
- To evaluate therapeutic interventions and patient outcomes in a developing country context.
- To highlight the challenges and possibilities in managing this rare complication.
Main Methods:
- Retrospective review of patients with WT and paraplegia from 1984 onwards.
- Analysis of patient demographics, symptom duration, tumor stage, and treatment details.
- Review of histopathology from primary tumors and spinal biopsies.
Main Results:
- Five cases of WT-associated paraplegia were identified.
- Imaging revealed epidural masses causing spinal cord compression.
- Four patients died; neurological recovery was limited and often temporary, with poor prognostic indicators including tumor anaplasia and invasion.
Conclusions:
- WT-associated spinal disease, though rare, can result in permanent neurological deficits.
- Late presentation in developing countries significantly worsens the prognosis.
- Surgical decompression may offer symptomatic relief and diagnostic material, with treatment tailored to available resources.
Purpose:
To document the clinical, imaging and histopathological features of five children with paraplegia due to Wilms' tumour (WT), highlighting therapeutic options and patient outcome in a developing country.
Methods:
Patients with WT and paraplegia seen at the Department of Paediatric Surgery since 1984 form the study cohort. Patient demographics, duration of neurological symptoms, stage of primary tumour, therapeutic intervention and outcome were recorded. Histology of the primary tumours and paraspinal or epidural biopsies were reviewed.
Results:
Five patients with WT and paraplegia were identified. Imaging showed epidural masses with paraspinal disease, cord displacement and compression. Four patients have died. Of the two patients with neurological recovery, one relapsed 4 months later. Histology revealed triphasic WT with one case showing anaplasia. Paraspinal or epidural biopsies confirmed WT with post-treatment changes. Three biopsies showed lymphovascular, perineurial and intraneural tumour invasion and one showed epidural venous invasion.
Conclusion:
Although rare, WT-associated spinal disease may cause permanent neurological deficit, adding considerably to the burden of disease. In developing countries where patients present late, the prognosis is poor, however surgery may provide immediate relief of compression symptoms and biopsy material. The treatment of choice will depend on the facilities available and the clinical circumstances.
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