Charles R. Fitz

Myxopapillary Ependymoma of the Filum Terminale and Cauda Equina in Childhood: Report of Seven Cases and Review of the Literature

Seven of fourteen children with spinal cord ependymoma had myxopapillary tumors of the filum terminale. These tumors made up 15.9% of all primary spinal neuroectodermal tumors in children (44 cases) seen during a 62-year period (1919 to 1981). Their clinical presentation, radiological features, pathological findings, treatment, and outcome are reported. Six of the seven patients were known to be alive at the time of writing. The seventh patient was lost to follow-up after 3 years without tumor recurrence. Of 5 patients whose primary mode of treatment was operation alone. 3 had intraspinal or intracranial recurrences. Despite tumor recurrences, 2 patients were long term survivors after further operation and irradiation, whereas the third patient recently received craniospinal irradiation for intracranial tumor recurrence. The 2 patients who did not have tumor recurrence after operation alone had been followed for 3 and 7 years, respectively. Two children with subtotal tumor resection and spinal irradiation had no recurrences at 1 and 17 years, respectively. Our data suggest that this unusual subtype of spinal ependymoma is not uncommon during childhood and has a good prognosis. All patients with this tumor require prolonged follow-up for tumor recurrence after operation and irradiation.

HYPOXIC‐ISCHAEMIC CEREBRAL INJURY IN THE TERM NEWBORN: CORRÉLATION OF CT FINDINGS WITH NEUROLOGICAL OUTCOME

For asphyxiated term infants, prédiction of neurological outcome based on clinical criteria alone is not always reliable. We have used changes in tissue density on CT scan (known to represent hypoxic‐ischaemic injury) as an adjunct to clinical examination to assess the severity of cerebral injury.

Extragonadal endodermal sinus tumors in children: a review of 24 cases.

Endodermal sinus tumors (EST) are highly malignant lesions with a tendency to recur locally and with a high incidence of metastatic disease at the time of diagnosis. The clinical and radiographic spectra of 24 patients with extragonadal EST are reported. There were 17 females and seven males and the mean age of presentation was 21 months. The primary lesion occurred in the sacrococcygeal region in 16 patients; in the vagina in two patients; in the anterior mediastinum in two patients; and in the bladder, liver, nasopharynx and posterior cranial fossa in one patient each. Computed tomography (CT) is the most accurate study in delineating the extent of primary lesions particularly in the pelvis and head and neck and also for demonstrating metastatic disease in the lungs. Singificant improvement in survival rates is obtained with a combination of surgery, chemotherapy and radiotherapy.

Hypoxic/ischaemic cerebral injury in the neonatal brain. A report of sonographic features with computed tomographic correlation.

Ultrasound has been used in 11 neonates whose history or clinical features suggested the possibility of hypoxic/ischaemic lesions. The ultrasound findings were correlated with computed tomographic findings in nine infants and with pathological findings in two. On ultrasound scan, areas of increased echoes represented both hypoxic/ischaemic and haemorrhagic lesions. However, the distinction between them could not be made with certainty. Cystic changes were shown clearly by ultrasound as were cerebral vascular pulsations in and adjacent to the areas of increased echoes. With computed tomography, hypoxic/ischaemic lesions were represented by areas of decreased density and haemorrhagic lesions by areas of increased density. Computed tomography failed to clearly demonstrate the cystic changes. Three types of lesions, viz. diffuse, focal and periventricular were based on the location of brain injury, the former two occurring in term infants and the latter in premature infants. Ultrasound has been shown to be of value for definition of the site and extent of hypoxic/ischaemic cerebral lesions in the newborn and for observation of their evolution.

Computed tomography and lymphogram correlation in children with hodgkin's disease

In 17 children with Hodgkins disease, abdominal computed tomography (CT) and bipedal lymphangiography findings were correlated in an attempt to assess the accuracy of CT in excluding the presence of retroperitoneal and pelvic lymphadenopathy. There was excellent correlation in 14 (82%) patients. In 13 of these, both studies were negative; in one, enlarged nodes were noted in the pelvis on both studies, which otherwise revealed no abnormality in the remainder of the abdomen. In one other patient, CT revealed lymphadenopathy high in the abdomen and these nodes were not filled with contrast medium at lymphangiography. Lymphangiography revealed pelvic lymphadenopathy in 2 (12%) patients in whom the CT scan was initially interpreted as normal. If strict attention is paid to adequate opacification of the bowel and retroperitoneal vasculature, CT is an accurate modality for excluding retroperitoneal and pelvic lymphadenopathy, particularly in older children.

A rare cause of spinal cord compression in childhood from intraspinal mesenchymal chondrosarcoma

SummaryTwo children presented with acute spinal cord compression by primary and metastatic intraspinal mesenchymal chondrosarcoma, a rare pediatric malignancy. Patients with the primary intraspinal tumor usually present early and often respond well to combined surgery, irradiation and chemotherapy. Patients with intraspinal metastases present late in the course of their disease and their prognoses are poor.

New Methods of Diagnosis

The application of special procedures such as arteriography, myelography, venography, and lymphangiography to the radiological investigation and follow-up of children with suspected or proven solid tumors is illustrated by body region.