Malignant Spinal Cord Compression Syndrome as an Initial Presentation of Testicular Cancer

Abstract

Malignant spinal cord compression syndrome (MSCCS) occurs in 2.5 to 5% of all oncological patients. In 20% of the cases, it is the initial manifestation. This syndrome is a rare event among germ cell tumors (GCT), occurring in only 1.7% of the patients. We present the case of a 24-year-old man who arrived at the emergency department with dysesthesia and paraparesis as well as urinary incontinence. Imaging studies showed an infiltrative lesion in the left testicle, pulmonary and hepatic metastatic disease, and a large retroperitoneal ganglionar conglomerate that infiltrated the spinal cord through the intervertebral foramina of the vertebra level T11 with displacement of the L1 vertebral body. A postoperative biopsy showed a pure embryonal carcinoma. In the initial approach of a young man who presents spinal cord compression, the presence of MSCCS associated with GCT should be considered as a possible cause. A high level of suspicion is required to achieve a timely diagnosis, to grant the patient the best possible outcome.

Metastatic Spinal Cord Compression as the First Manifestation of Malignancy – A Retrospective Study of Surgical Outcome from Single Institution Spine Tumor Registry

“…Epidemiological studies have reported that MSCC could be the initial presentation of malignancy up to 20%, [3][4][5] and it can occur in any cancer type. [10][11][12] Regardless of whether the site of the primary cancer is known or not, surgery does play a role in spinal metastases management because MSCC is an oncological emergency that necessitates immediate surgical intervention. According to a recent review, an integrated multidisciplinary approach is needed for the management of spinal metastases due to its complexity.…”