Primary Extramedullary, Extradural Cervical Spine Seminoma

Abstract

While extragonadal seminomas resulting in spinal cord compression are rarely reported in the literature, most have been treated with surgical decompression followed by radiation therapy. In this report, we present the unique and interesting case of a 38-year-old man who initially presented as an outpatient with a chief complaint of axial neck pain and lateral thoracic wall pain. After an extensive malignancy workup, he was diagnosed with a primary cervical spine seminoma and was treated with a C6-T1 laminectomy with posterior spinal instrumentation from C5 to T2. He has since undergone chemotherapy with cisplatin, vinblastine, and bleomycin, and at 24-month follow-up, he remains asymptomatic with no signs of recurrent disease.

Figure 1

Initial X-rays of the cervical spine (AP and lateral views) demonstrating no obvious spinal pathology.

Figure 2

Sagittal and axial MRI images of the cervical spine at the C6–7 level demonstrating the posterior spinal lesion leading to spinal cord compression.

Figure 3

Sagittal and axial CT images of the cervical spine showing erosive changes to the C7 spinous process.

Figure 4

Photographs of the resected specimen containing lamina and tumor.

Figure 5

Postoperative AP and lateral cervical spine radiographs demonstrating posterior spinal instrumentation from C5 to T2.

Figure 6

A, Low power field histology image demonstrating bony trabeculae containing both tumor cells and lymphocytes. B, High power field histology image demonstrating dark small lymphocytes and squared large seminoma cells.

Figure 7

Histology slides with (A) placental alkaline phosphatase and (B) proto-oncogene c-Kit (CD117) stain demonstrating the presence of seminoma cells.