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Poster 31: Extraskeletal Myxoid Chondrosarcoma Causing Lumbar Polyradiculopathy: A Case Report
PM&R
vital capacity (VC) and negative inspiratory force (NIF) was recommended until a stable improving trend was seen. Setting: Quaternary care academic hospital. Results: The patient was admitted to inpatient rehabilitation and then transferred back for chemotherapy to the oncology floor for a total of 3 consecutive cycles. The patient progressed from requiring maximal assistance of 2 people for bed mobility and moderate to maximal assistance for activities of daily living (ADL) and toileting, to being able to ambulate independently with a cane and being independent with his ADLs. Discussion: To our knowledge, this is a unique case of a patient with extragonadal metastatic germ cell carcinoma with secondary AIDP, who showed an exceptional clinical improvement secondary to combined chemotherapy and aggressive inpatient rehabilitation. Conclusions: Comprehensive diagnosis and treatment of germ cell carcinoma and AIDP, along with recognition of immediate potential complications, like respiratory failure, are quintessential elements for the rehabilitation consultation specialist.
Poster 31 Extraskeletal Myxoid Chondrosarcoma Causing Lumbar Polyradiculopathy: A Case Report. Trung Vu, DO (Sinai Hospital, Baltimore, MD); Henry York. Disclosures: T. Vu, None. Patients or Programs: A 42-year-old man with a history of tobacco abuse and extraskeletal myxoid chondrosarcoma. Program Description: While awaiting stereotactic radiation therapy for chondrosarcoma, the patient presented to an acute hospital with a 2 -week history of falling, left leg weakness, urinary retention, and a back nodule. MRI showed destructive bone lesions in the L4 and L5 vertebrae with a left-sided lumbar paraspinal soft tissue mass extending into the spinal cord and retroperitoneal region. He underwent intralesional tumor debulking of what was confirmed to be an extraskeletal myxoid chondrosarcoma; L4 and L5 partial corpectomies, L3-S1 laminectomies and foraminotomies, and pedicle screw instrumentation were performed during the same procedure. He later underwent 5 radiation treatments. Postoperative MRI demonstrated residual tumor on the left psoas and iliac muscles extending to the left L4-L5 neural foramen. He was transferred to our acute inpatient rehabilitation facility. Admission examination was significant for normal strength in all limbs except for 4/5 right long toe extensors; 1/5 left hip flexors, knee extensors, and ankle dorsiflexors; 3/5 left long toe extensors and ankle plantar flexors. Left lower limb reflexes were absent at the knee and ankle compared with 2⫹ in the right lower limb. Sensation was normal from C2 to S5. He required assistance with mobility and activities of daily living.
Vol. 2, Iss. 9S, 2010
S21
Setting: Freestanding rehabilitation hospital. Results: After 1 week of acute inpatient rehabilitation, his proximal left leg key muscle strength improved by 1 to 2 muscle grades. He attained modified independence with ambulation using a rolling walker and was discharged home with his family. Discussion: Extraskeletal myxoid chondrosarcoma is a rare, usually indolent, tumor that can metastasize to the perineum, retroperitoneum, and psoas muscles. Femoral peripheral neuropathies have been described, but this is the first description of this tumor causing lumbar polyradiculopathy. Conclusions: Extraskeletal myxoid chondrosarcoma is a rare tumor that can cause polyradiculopathy. After aggressive surgical and radiation therapy, residual weakness from chondrosarcoma may improve with comprehensive inpatient rehabilitation.
Poster 32 Intravascular Lymphoma Due to Purine Analogue Use for Inflammatory Bowel Disease. Michelle Weiner, DO, MPH (University of Miami, Miami, FL); Kevin L. Dalal, MD. Disclosures: M. Weiner, None. Patients or Programs: A 63-year-old man with Crohn disease and intravascular lymphoma. Program Description: Patient with a PMHx significant for Crohn disease presented with acute onset of pain with sudden loss of strength in his lower extremities along with urinary and fecal incontinence. Patient exhibited trace motor strength and hyporeflexia in bilateral lower extremities and decreased pinprick and vibratory sensation. Imaging showed increased hyperintensity in the central cord, starting at T11 and progressing distally; there were no intracerebral abnormalities. CSF analysis revealed a small T-cell population with no diagnostic immuno-phenotypic abnormalities or oligoclonal bands. All stains and cultures were negative. The initial diagnosis was that of spinal cord infarct versus transverse myelitis. The patient showed some functional improvement after undergoing a course of inpatient rehabilitation and treatment with steroids. Patient was maintained on a preprandial opiate regimen to slow bowel motility as well as 6-mercaptopurine to treat Crohn. Setting: Tertiary academic medical center inpatient rehabilitation unit. Results: During the ensuing months, the patient’s neurologic status fluctuated. The patient eventually developed acute onset of left upper extremity weakness, left central facial paralysis and word-finding difficulty. Imaging revealed abnormal signal density from T1-3 on the right side of the cord. Brain imaging showed a large lesion in the right precentral gyrus with multiple tiny enhancing foci. The differential included inflammatory processes such as vasculitis,
vital capacity (VC) and negative inspiratory force (NIF) was recommended until a stable improving trend was seen. Setting: Quaternary care academic hospital. Results: The patient was admitted to inpatient rehabilitation and then transferred back for chemotherapy to the oncology floor for a total of 3 consecutive cycles. The patient progressed from requiring maximal assistance of 2 people for bed mobility and moderate to maximal assistance for activities of daily living (ADL) and toileting, to being able to ambulate independently with a cane and being independent with his ADLs. Discussion: To our knowledge, this is a unique case of a patient with extragonadal metastatic germ cell carcinoma with secondary AIDP, who showed an exceptional clinical improvement secondary to combined chemotherapy and aggressive inpatient rehabilitation. Conclusions: Comprehensive diagnosis and treatment of germ cell carcinoma and AIDP, along with recognition of immediate potential complications, like respiratory failure, are quintessential elements for the rehabilitation consultation specialist.
Poster 31 Extraskeletal Myxoid Chondrosarcoma Causing Lumbar Polyradiculopathy: A Case Report. Trung Vu, DO (Sinai Hospital, Baltimore, MD); Henry York. Disclosures: T. Vu, None. Patients or Programs: A 42-year-old man with a history of tobacco abuse and extraskeletal myxoid chondrosarcoma. Program Description: While awaiting stereotactic radiation therapy for chondrosarcoma, the patient presented to an acute hospital with a 2 -week history of falling, left leg weakness, urinary retention, and a back nodule. MRI showed destructive bone lesions in the L4 and L5 vertebrae with a left-sided lumbar paraspinal soft tissue mass extending into the spinal cord and retroperitoneal region. He underwent intralesional tumor debulking of what was confirmed to be an extraskeletal myxoid chondrosarcoma; L4 and L5 partial corpectomies, L3-S1 laminectomies and foraminotomies, and pedicle screw instrumentation were performed during the same procedure. He later underwent 5 radiation treatments. Postoperative MRI demonstrated residual tumor on the left psoas and iliac muscles extending to the left L4-L5 neural foramen. He was transferred to our acute inpatient rehabilitation facility. Admission examination was significant for normal strength in all limbs except for 4/5 right long toe extensors; 1/5 left hip flexors, knee extensors, and ankle dorsiflexors; 3/5 left long toe extensors and ankle plantar flexors. Left lower limb reflexes were absent at the knee and ankle compared with 2⫹ in the right lower limb. Sensation was normal from C2 to S5. He required assistance with mobility and activities of daily living.
Vol. 2, Iss. 9S, 2010
S21
Setting: Freestanding rehabilitation hospital. Results: After 1 week of acute inpatient rehabilitation, his proximal left leg key muscle strength improved by 1 to 2 muscle grades. He attained modified independence with ambulation using a rolling walker and was discharged home with his family. Discussion: Extraskeletal myxoid chondrosarcoma is a rare, usually indolent, tumor that can metastasize to the perineum, retroperitoneum, and psoas muscles. Femoral peripheral neuropathies have been described, but this is the first description of this tumor causing lumbar polyradiculopathy. Conclusions: Extraskeletal myxoid chondrosarcoma is a rare tumor that can cause polyradiculopathy. After aggressive surgical and radiation therapy, residual weakness from chondrosarcoma may improve with comprehensive inpatient rehabilitation.
Poster 32 Intravascular Lymphoma Due to Purine Analogue Use for Inflammatory Bowel Disease. Michelle Weiner, DO, MPH (University of Miami, Miami, FL); Kevin L. Dalal, MD. Disclosures: M. Weiner, None. Patients or Programs: A 63-year-old man with Crohn disease and intravascular lymphoma. Program Description: Patient with a PMHx significant for Crohn disease presented with acute onset of pain with sudden loss of strength in his lower extremities along with urinary and fecal incontinence. Patient exhibited trace motor strength and hyporeflexia in bilateral lower extremities and decreased pinprick and vibratory sensation. Imaging showed increased hyperintensity in the central cord, starting at T11 and progressing distally; there were no intracerebral abnormalities. CSF analysis revealed a small T-cell population with no diagnostic immuno-phenotypic abnormalities or oligoclonal bands. All stains and cultures were negative. The initial diagnosis was that of spinal cord infarct versus transverse myelitis. The patient showed some functional improvement after undergoing a course of inpatient rehabilitation and treatment with steroids. Patient was maintained on a preprandial opiate regimen to slow bowel motility as well as 6-mercaptopurine to treat Crohn. Setting: Tertiary academic medical center inpatient rehabilitation unit. Results: During the ensuing months, the patient’s neurologic status fluctuated. The patient eventually developed acute onset of left upper extremity weakness, left central facial paralysis and word-finding difficulty. Imaging revealed abnormal signal density from T1-3 on the right side of the cord. Brain imaging showed a large lesion in the right precentral gyrus with multiple tiny enhancing foci. The differential included inflammatory processes such as vasculitis,