We report the case of a 54-year-old man with no medical or surgical history, who reported occasional intermittent chest pain that resolved spontaneously since March 2000.
In March 2001 this pain began to be more frequent, so the study began without finding pathology.
In October 2001 he began with what he described as "extraineal sensation" in the lower limbs, and went to the clinic week when in a few hours he lost complete mobility of lower extremities and sensitivity from region.
He came to the Emergency Department of Mendaro Hospital where an analysis was performed, an urgent chest X-ray (Rx) and an EKG with results within normal limits but with a suggestive clinic of spinal cord paraparesis.
The physical examination carried out in this service also showed paraparesis of IDS 3/5 and IBD 0-1/5.
Sensitivity was also affected and hypoesthesia was detected below D9-10, with bilateral osteotendinous thickening of the bronchi and Babinsky.
In the X-ray of the dorsal and cervical spine as well as in the thoracic Computerized Axial Tomography (CAT) (3-10-2001), a posterior mediastinal mass suggestive of a neurogenic tumor was observed.
She was admitted to neurosurgery with the diagnosis of acute myelopathy with possible spinal cord compression by tumor at the level of D4 in the posterior mediastinum.
Magnetic Resonance Imaging (MRI) (4-10-2001) revealed an epidural mass displacing the medullary cord forward at D4 level.
That same day she was operated urgently carrying out an extended laminectomy with tumor exeresis.
During surgery, a grayish epidural tumour attached to a dural arch extending bilaterally but more to the right was observed through the foramen conjunction.
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The pathology of the surgical intervention revealed a connective tissue infiltrated by malignant melanoma without bone fragments, but with margins.
However, it was not possible to determine whether the lesions were metastatic or primary originated in meninges.
The immediate postoperative period was uneventful, recovering the left hemiplegia at 4/5.
In post-intervention NMR (10-10-01), two remaining nodular tumors were observed, one in right space and the other slightly posterior.
The study of dermatology and dentistry services was negative.
Pathogenesis as the first therapeutic measure was ruled out, and radiation therapy was initiated promptly.
Simulation and 3-D planning were performed. Treatment was initiated on November 8, 2001 using 2 fields AP and PA and 2 oblique fields at 200 cGy/session up to a total of 48 Gy, including D2 the vertebral body.
MRI after this treatment (15/01) revealed two nodules in relation to well-known tumor remnants, which had not changed from a previous study of 10-10-01.
In February 2002, the patient was assessed by the Department of Ontario Medical Center, and a PET was requested to assess the persistence or absence of local disease, demonstrate the presence or absence of distant disease, and try to find a possible primary tumor
This test (05-02) was reported with uptake in two upper dorsal segments and postmedial region of the lung parenchyma (granulation tissue vs primary injury).
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On 06-03-02 a surgical intervention was performed by right radical cystotomy with the removal of a tumor mass, completing the neurocipherans the resection because the mass was intimately adhered to the dura mater.
The pathology report reported the existence of a malignant melanoma constituting a 2.5 cm non-encapsulated nodule containing soft tissues, connective, adipose and intraneural in large nerve trunks.
Microscopically, the tumor proliferation was in contact with the external surgical edge of the fragment.
The patient accepted the treatment proposed with IFN alfa-2b at a dose of 20 million.
U iv./day x 5 days for 4 weeks and then 10 mil.U sc/3 times a week to complete 52 weeks.
Treatment was well tolerated, except for one episode of neutropenia, which required medication administration.
MRI showed postsurgical changes that had decreased with respect to previous MRI scans of the 20/10 catheter, with no evidence of tumor or spinal cord compression at present.
