Spinal Cord Compression as Clinical Presentation of Malignant Hematopoietic Diseases in Pediatric Patients

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Published Dec 31, 2022
DOI: https://doi.org/10.18103/mra.v10i12.3317

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María Alejandra Deu
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
María Ceciclia Bertone
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Luisina Belén Peruzzo
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Carla Luciana Pennella
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Cristian Germán Sanchez La Rosa
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Myriam Ruth Guitter
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Elizabeth Melania Alfaro
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
Pedro Zubizarreta
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.
María Sara Felice
Pediatric Hematology Oncology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires C1245, Argentina.

Abstract

Spinal cord compression (SCC) is an unusual manifestation of leukemias and lymphomas in children and defines an oncological emergency frequently unsuspected, being a cause of severe sequelae. Our aim was to analyze the characteristics of patients who presented signs or symptoms of spinal cord compression in early phases of malignant hematopoietic diseases. From November-1988 to July-2022, 3878 patients with leukemia and lymphoma were diagnosed. Of them, 36 children (0.92%) presented spinal cord compression signs/symptoms in early phases of their diagnosis: Acute Lymphoblastic Leukemia (n=18), Acute Myeloblastic Leukemia and Myeloid Sarcoma (n=7), Non-Hodgkin Lymphomas (n=9) and Hodgkin Lymphoma (n=2). Clinical characteristics, images and hematological findings, treatment strategies, results and sequelae were analyzed. Sex distribution was 3.5/1 (M/F) and the media age at diagnosis was 10 (range: 4.9-16.9) years. The most common symptoms were back pain (34/36), functional impotence (27/36) and sphincter compromise (10/36). The media time from symptom onset to diagnosis was 47,5 (range: 0-300) days. Magnetic resonance imaging was performed on 33 (92%) patients and showed epidural mass (n=16) or vertebral collapse (n=17) in all of them. Two patients received initial radiotherapy and 11 decompressive surgeries for the management of the urgency spinal cord compression. Bone marrow aspiration was the diagnostic procedure in 69% of cases. All patients received chemotherapy and 94% achieved complete remission. Severe sequelae were observed in 10 patients (paraplegia with neurogenic bladder and kyphoscoliosis). Leukemia and lymphoma should be considered as a differential diagnosis when spinal cord compression is suspected, and magnetic resonance imaging is the mandatory study to confirm this diagnosis as a matter of urgency. Bone marrow involvement was evident due to hematological alterations in 95% of cases allowing to guide the diagnosis and initiate treatment early to reduce sequelae.

Article Details

How to Cite
DEU, María Alejandra et al. Spinal Cord Compression as Clinical Presentation of Malignant Hematopoietic Diseases in Pediatric Patients. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3317>. Date accessed: 27 apr. 2024. doi: https://doi.org/10.18103/mra.v10i12.3317.
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Vol 10 No 12 (2022): December issue, Vol.10 Issue 12
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References

1. Rheingold S, Lange B. Oncological emergencies. In: Pizzo, PA., Poplack David G. Principles and Practice of Pediatric Oncology. Seventh edition. Philadelphia: Lippincott Company; 2015.
2. Aysun S, Topçu M, Günay M, Topaloğlu H. Neurologic features as initial presentations of childhood malignancies. Pediatr Neurol. 1994 Feb;10(1):40-3. doi: 10.1016/0887-8994(94)90065-5. PMID: 8198671..
3. Gunes D, Uysal KM, Cetinkaya H, Tekin HG, Yuceer N, Sarialioglu F, Olgun N. Paravertebral malignant tumors of childhood: analysis of 28 pediatric patients. Childs Nerv Syst. 2009 Jan;25(1):63-9. doi: 10.1007/s00381-008-0717-2. Epub 2008 Oct 9. PMID: 18843494.
4. Hoyoux C, Forget P, Piette C, Dresse MF, Florkin B, Rausin L, Thiry A. Paravertebral Burkitt's Lymphoma in a Child: An Unusual Presentation. Case Rep Med. 2012;2012:891714. doi: 10.1155/2012/891714. Epub 2012 Nov 24.
5. De Martino L, Spennato P, Vetrella S, Capasso M, Porfito C, Ruotolo S, Abate ME, Cinalli G, Quaglietta L. Symptomatic malignant spinal cord compression in children: a single-center experience. Ital J Pediatr. 2019 Jul 12;45(1):80. doi: 10.1186/s13052-019-0671-5. PMID: 31300063; PMCID: PMC6626347.
6. Tantawy AA, Ebeid FS, Mahmoud MA, Shepl OE. Spinal cord compression in childhood pediatric malignancies: multicenter egyptian study. J Pediatr Hematol Oncol. 2013 Apr;35(3):232-6. doi: 10.1097/MPH.0b013e318270b210. PMID: 23511492.
7. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol. 2005 Jan;6(1):15-24. doi: 10.1016/S1470-2045(04)01709-7. PMID: 15629272.
8. Mora J, Wollner N. Primary Epidural Non-Hodgkin Lymphoma: Spinal Cord Compression Syndrome as the Initial Form of Presentation in Childhood Non-Hodgkin Lymphoma. Medical and Pediatric Oncology 1999 Feb; 32(2):102–105.
9. Samuda GM, Cheng MY, Yeung CY. Back pain and vertebral compression: an uncommon presentation of childhood acute lymphoblastic leukemia. J Pediatr Orthop. 1987 Mar-Apr;7(2):175-8. PMID: 2951397.
10. Kelly KM, Lange B. Oncologic emergencies. Pediatr Clin North Am. 1997 Aug;44(4):809-30. doi: 10.1016/s0031-3955(05)70531-9. PMID: 9286286.
11. Pollono D, Tomarchia S, Drut R, Ibañez O, Ferreyra M, Cédola J. Spinal cord compression: a review of 70 pediatric patients. Pediatr Hematol Oncol. 2003 Sep;20(6):457-66. PMID: 14631620.
12. Romero P, Manterola A, Martínez E, Villafranca E, Domínguez MA, Arias F. Compresión medular [Medullar compression]. An Sist Sanit Navar. 2004;27 Suppl 3:155-62. Spanish. PMID: 15723114.
13. Lewis DW, Packer RJ, Raney B, Rak IW, Belasco J, Lange B. Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer. Pediatrics. 1986 Sep;78(3):438-43. PMID: 3748677.
14. Joaquim AF, Ghizoni E, Valadares MGC, Appenzeller S, Aguiar SDS, Tedeschi H. Spinal tumors in children. Rev Assoc Med Bras (1992). 2017 May;63(5):459-465. doi: 10.1590/1806-9282.63.05.459. PMID: 28724045.
15. Daley MF, Partington MD, Kadan-Lottick N, Odom LF. Primary epidural burkitt lymphoma in a child: case presentation and literature review. Pediatr Hematol Oncol. 2003 Jun;20(4):333-8. PMID: 12746166.
16. Pui CH, Dahl GV, Hustu HO, Murphy SB. Epidural spinal cord compression as the initial finding in childhood acute leukemia and non-Hodgkin lymphoma. J Pediatr. 1985 May;106(5):788-92. doi: 10.1016/s0022-3476(85)80357-7. PMID: 3858493.
17. Ses E, N'dri Oka D, Varlet G, Koffi K, Boni NR, Ba Zeze V. Compression médullaire par lymphome de Burkitt. Analyse de 7 observations [Medullary compression by Burkitt lymphoma. Analysis of 7 cases]. Neurochirurgie. 2001 Dec;47(6):552-6. French. PMID: 11915614.
18. Raco A, Cervoni L, Salvati M, Delfini R. Primary spinal epidural non-Hodgkin's lymphomas in childhood: a review of 6 cases. Acta Neurochir (Wien). 1997;139(6):526-8. doi: 10.1007/BF02750995. PMID: 9248586.
19. Dechambenoit G, Piquemal M, Giordano C, Cournil C, Ba Zeze V, Santini JJ. Spinal cord compression resulting from Burkitt's lymphoma in children. Childs Nerv Syst. 1996 Apr;12(4):210-4. doi: 10.1007/BF00301252.
20. Turgut M, Ozcan OE, Erbengi A. Burkitt's lymphoma: an unusual cause of childhood paraplegia. Childs Nerv Syst. 1991 Jun;7(3):169-71. doi: 10.1007/BF00776717. PMID: 1878873.
21. Gupta V, Srivastava A, Bhatia B. Hodgkin disease with spinal cord compression. J Pediatr Hematol Oncol. 2009 Oct;31(10):771-3. doi: 10.1097/MPH.0b013e31819c1ff0. PMID: 19636273.
22. Samadian M, Vahidi S, Khormaee F, Ashraf H. Isolated, primary spinal epidural Hodgkin's disease in a child. Pediatr Neurol. 2009 Jun;40(6):480-2. doi: 10.1016/j.pediatrneurol.2009.01.006. PMID: 19433288.
23. Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression. Hematol Oncol Clin North Am. 2010 Jun;24(3):537-51. doi: 10.1016/j.hoc.2010.03.011. PMID: 20488352.
24. Puzik A, Moske-Eick O, Kontny U. A young boy with a paravertebral mass and symptoms of spinal compression. J Neurooncol. 2014 Sep;119(2):445-6. doi: 10.1007/s11060-014-1517-z. Epub 2014 Jul 1. PMID: 24980039.
25. Meltzer JA, Jubinsky PT. Acute myeloid leukemia presenting as spinal cord compression. Pediatr Emerg Care. 2005 Oct;21(10):670-2. doi: 10.1097/01.pec.0000181422.94847.bb. PMID: 16215471.
26. Ardern-Holmes S, Esrick E, Degar B, Vergilio J, Ullrich NJ. Back pain and spinal cord compression: An uncommon presentation of childhood acute myeloid leukemia. Journal of Pediatric Neurology 9 (2011) 109–113.
27. Olcay L, Aribaş BK, Gökçe M. A patient with acute myeloblastic leukemia who presented with conus medullaris syndrome and review of the literature. J Pediatr Hematol Oncol. 2009 Jun;31(6):440-7. doi: 10.1097/MPH.0b013e31819ed24b. PMID: 19648794.
28. Felice MS, Zubizarreta PA, Alfaro EM, Gallego MS, Cygler AM, Rosso DA, Rossi JG, Sackmann-Muriel F. Good outcome of children with acute myeloid leukemia and t(8;21)(q22;q22), even when associated with granulocytic sarcoma: a report from a single institution in Argentina. Cancer. 2000 Apr 15;88(8):1939-44.
29. Molina B, Lassaletta A, Andion M, Gonzalez-Vicent M, López-Pino MA, Madero L. A persistent epidural mass in a child with B-lineage ALL. Pediatr Blood Cancer. 2010 Oct;55(4):727-9. doi: 10.1002/pbc.22682. PMID: 20535830.
30. Hashi S, Goodwin CR, Ahmed AK, Sciubba DM. Management of extranodal lymphoma of the spine: a study of 30 patients. CNS Oncol. 2018 Apr;7(2):CNS11. doi: 10.2217/cns-2017-0033. Epub 2018 Apr 30. PMID: 29706086; PMCID: PMC5977280.
31. Cugati G, Singh M, Pande A, Ramamurthi R, Balasubramanyam M, Sethi SK, Singh AK. Primary spinal epidural lymphomas. J Craniovertebr Junction Spine. 2011 Jan;2(1):3-11. doi: 10.4103/0974-8237.85307. PMID: 22013369; PMCID: PMC3190427.