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AJNR - American Journal of Neuroradiology

Published ahead of print on January 9, 2008
doi: 10.3174/ajnr.A0924

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Malignant Transformation of a Lipomyelocele into a Rhabdomyosarcoma?

A.M. O'Connell^a, D. Allcutt^b, F. Brett^c and S. Ryan^a

^a Department of Radiology, Children's University Hospital, Dublin, Ireland
^b Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
^c Department of Neuropathology, Beaumont Hospital, Dublin, Ireland

View larger version (63K): [in this window] [in a new window]   Fig 1. Photograph of a complex ulcerating hemangioma over the sacrum in a full-term neonate on day 1.

View larger version (97K): [in this window] [in a new window]   Fig 2. Sagittal T1-weighted MR image obtained at 3 months confirms the sonographic finding of the tethered spinal cord (arrowhead) ending in a lipomyelocele (arrow).

View larger version (105K): [in this window] [in a new window]   Fig 3. A, Sagittal T1-weighted MR image at 3 years shows a new large homogeneous mass of low signal intensity (arrow), apparently arising from the lipomyelocele and distal spinal cord within the spinal canal. B, Postcontrast T1-weighted sagittal MR image shows multiple foci (arrowheads) of high signal intensity in the distal thoracic and lumbar spinal cord consistent with metastatic seeding. C, Sagittal postcontrast T1-weighted MR image demonstrates multiple foci (arrowheads) of high signal intensity in the brain stem and cervical and upper thoracic spinal cord, consistent with metastatic seeding.

View larger version (150K): [in this window] [in a new window]   Fig 4. Resection of this sacral mass revealed a pleomorphic malignant spindle cell tumor at pathology, consistent with a rhabdomyosarcoma (hematoxylin-eosin).