images in clinical medicine
Wien Klin Wochenschr (2008) 120: 538 DOI 10.1007/s00508-008-1020-7 Printed in Austria © Springer-Verlag 2008
Wiener klinische Wochenschrift The Middle European Journal of Medicine
Spinal cord compression caused by multiple spinal osteochondromas
Fig. 1
A 15-year-old boy with positive family history of osteochondromatosis presented with a three-month history of progressive paraparesis and a month history of urinary incontinence. The patient underwent irradiation of the whole neuroaxis for meduloblastoma at the age of 18 months. The CT and MRI showed multilevel osteochondromas of the spine with irregularly narrowed spinal canal to the level of complete obliteration, and spinal cord compression and displacement (Fig. 1A and 1B). MRI delineated the extent of the osteochondromas, particularly the cartilage cap, more accurately than CT. MRI was also superior in visualizing spinal cord compression. CT, however, was performing better in analysis of the bony structures of the tumors, calcifications, and in assessment of the spinal canal deformity (Fig. 1C). After laminectomy and partial resection of the tumor masses, neurological deficits remained, despite achieved decompression of the neural structures. Postoperative CT and MRI of the spine revealed residual exostosis that caused displacement of the spinal cord and postischemic changes of the spinal cord at the level Th2 (Fig. 2). Histological analysis of the removed specimens confirmed the benign nature of the tumors. Osteochondroma is a cartilaginous tumor, the most common benign tumor of the bone. It may be solitary, or multiple (osteochondromatosis, usually with autosomal dominant inheritance) [1, 2]. We believe that the osteochondromatosis in our patient was hereditary with possible acceleration of progression of the tumor growth caused by irradiation since it may be induced by radiation exposure [3]. Kristina Potocki, Maja Prutki, Marko Kralik, Lidija Palezac, Petar Skavic, Ranka Stern Padovan
References 1. Dahlin DC, Unni KK (1986) Osteochondroma (osteocartilaginous exostosis). In: Dahlin DC, Unni KK (eds) Bone tumors, general aspects, and data on 8542 cases, 4th edn. Thomas, Springfield, pp 18–32 2. Solomon L (1964) Hereditary multiple exostoses. Am J Hum Genet 16: 351–363 3. Libshitz HI, Cohen MA (1982) Radiation induced osteochondromas. Radiology 142: 643–647 Key words: Osteochondroma, hereditary multiple exostosis, spinal cord compression, radiation, magnetic resonance imaging. Correspondence: Maja Prutki, MD, Clinical Hospital Center Zagreb, Clinical Institute of Diagnostic and Interventional R adiology, Kispaticeva 12, 10000 Zagreb, Croatia, E-mail:
[email protected]
Fig. 2
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17–18/2008 Spinal cord compression caused by multiple spinal osteochondromas
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