Primary Extramedullary, Extradural Cervical Spine Seminoma:
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Malignant spinal cord compression occurs in 5% to 14% of all patients diagnosed with cancer. An unusual case of a patient with a primary extragonadal seminoma, a germ cell tumor, located in the posterior elements of the cervical spine causing malignant spinal cord compression is reported.

A 38-year-old man presented with a 1-month history of axial neck pain and right lateral thoracic pain. The pain was localized to the right 11th intercostal space and was exacerbated by inspiration. On physical examination, there was tenderness to palpation about his posterior neck. Motor and sensory exams were within normal limits with no obvious neurologic deficit. The patient was initially treated conservatively with NSAIDs and physical therapy. However, 6 weeks later, the patient returned without symptomatic improvement and new onset of right upper extremity radiculopathy.

MRI of the cervical spine was obtained and demonstrated a nongeographic, destructive lesion in the posterior elements of the cervical spine arising from the spinous process of C7 and evidence of spinal cord compression. CT scan of the cervical spine demonstrated erosive changes to the C7 spinous process. Chest/abdomen/pelvis CT scan revealed metastatic disease of the right 11th rib however, no primary mass was identified. Given the nature of the patient's symptoms and MRI findings, the patient was indicated for surgical intervention for primary resection of the tumor.

A C6–T1 laminectomy was performed to gain access to the mass. The tumor was identified and wide en bloc resection of the mass was performed. Posterior spinal instrumentation from C5 to T2 was then performed. The patient was discharged from the hospital on postoperative day 5 with orthopaedic and oncologic follow-up. He has since recovered well and has undergone three cycles of chemotherapy with cisplatin, vinblastine and bleomycin. Postoperative radiographs show hardware in excellent position. At 24-month follow-up, he was asymptomatic with no evidence of recurrence of the spinal mass or progression of the rib lesion. He continues to be monitored with periodic spine and testes MRIs and chest CT scans.