CLINICAL COURSE:
The patient had a two-week history of lower extremity weakness progressing to paralysis. He had no history of upper extremity weakness or respiratory problems. He also had fecal and urinary incontinence. On September 22, he had a fever, slight congestion and a rash. On September 25, he was thought to have scarlet fever. Beginning on the 27th of September, lower extremity weakness was noted which progressed to paraplegia. Guillain-Barre syndrome was suspected at first.
On admission to Children's Hospital of Pittsburgh, a magnetic resonance imaging scan (MRI) reportedly showed a left adrenal mass with extension through the intervertebral foramina into the epidural space with extreme compression of the spinal cord. He had minimal leg movement at this time and an epidural neuroblastoma, T9-L1 was suspected. On October 13, he underwent a T9-L1 osteoplastic laminotomy, decompression of the spinal cord and a biopsy of the epidural tumor.
A bone scan on October 16, showed decreased uptake at T11-T12. A CT scan that day showed an intrathoracic paravertebral mass with intrathecal extent and extension to the right paravertebral region at T11-T12 with intrathecal extension to T3 and osseous destruction of his posterior vertebral body. A bone marrow biopsy of the iliac crest showed no tumor. On the 18th of October, a double lumen Broviac catheter was placed and he was started on a chemotherapeutic regimen of cisplatin, VP-16, and bleomycin. On October 25, he was started on hyperalimentation and was noted to have some movement of his lower extremities.
He was discharged on October 27, and continued on hyperalimentation. The next day he was reported to be afebrille after episodes of vomiting and diarrhea with black stool. On October 29, he looked "OK" and was eating a "popsicle" while watching television. A few moments later he was lifeless. He was taken to a local hospital and was pronounced dead. His body was transferred to Children's Hospital of Pittsburgh for autopsy.
Diagnostic Biopsy
Autopsy Diagnoses
