Paraspinal mass in a child.

Accepted 6 September 1995 A nine-year-old girl was admitted to our hospital with difficulty in walking in September 1993. On physical examination there was a solid mass of 10 x 10 cm in the lumbosacral region and the patient was unable to walk or stand. Bilateral deep tendon reflexes of the lower extremities were hypoactive and muscle strength was also decreased. There was hypoesthesia at L4, L5 and S 1 on both legs. Babinsky test was negative bilaterally. On lumbar spine radiographs there were lytic and sclerotic lesions on the corpus of the fifth lumbar vertebra and sacrum. Results of bone scintigraphy showed intense tracer accumulation at the L5 and L5-S1 level on both blood pool and delayed images. Magnetic resonance imaging (MRI) of the lumbosacral spine showed a large mass which invaded the multifundus and both psoas muscles. The mass extended caudally to the pelvis. Both intervertebral foramina were dilated at L4-5, L5-S1, and S1-2 levels and the right intervertebral foramen on S2-3 level (figure 1). The mass extended into the spinal canal through these foramina and filled the spinal canal between L5 and S3 (figure 2). The mass showed high-signal intensity on T2-weighted images and isointensity with adjacent muscles on Tl-weighted images. After contrast enhancement with gadolinium DTPA the mass showed enhancement almost homogeneously (figure 3). The soft tissue component of the mass extended between L4 and S3 levels. The fifth lumbar and the first two sacral vertebrae were of low signal intensity on Tiweighted and of high signal intensity on T2-weighted images. Both L5 and S2 vertebral bodies showed inhomogeneous contrast enhancement but Si vertebra showed only a few enhanced regions (figure 3). Left L5 hemilaminectomy, left laminotomy and biopsy from the epidural mass were performed.