Poster 31: Extraskeletal Myxoid Chondrosarcoma Causing Lumbar Polyradiculopathy: A Case Report

vital capacity (VC) and negative inspiratory force (NIF) wasrecommended until a stable improving trend was seen.Setting: Quaternary care academic hospital.Results: The patient was admitted to inpatient rehabilita-tion and then transferred back for chemotherapy to theoncology floor for a total of 3 consecutive cycles. The patientprogressed from requiring maximal assistance of 2 people forbed mobility and moderate to maximal assistance for activi-ties of daily living (ADL) and toileting, to being able toambulate independently with a cane and being independentwith his ADLs.Discussion: To our knowledge, this is a unique case of apatient with extragonadal metastatic germ cell carcinomawith secondary AIDP, who showed an exceptional clinicalimprovement secondary to combined chemotherapy and ag-gressive inpatient rehabilitation.Conclusions: Comprehensive diagnosis and treatment ofgerm cell carcinoma and AIDP, along with recognition ofimmediate potential complications, like respiratory failure,are quintessential elements for the rehabilitation consultationspecialist.

Poster 31Extraskeletal Myxoid ChondrosarcomaCausing Lumbar Polyradiculopathy: A CaseReport.Trung Vu, DO (Sinai Hospital, Baltimore, MD);Henry York.

Disclosures: T. Vu, None.Patients or Programs: A 42-year-old man with a historyof tobacco abuse and extraskeletal myxoid chondrosarcoma.Program Description: While awaiting stereotactic radi-ation therapy for chondrosarcoma, the patient presented toan acute hospital with a 2 -week history of falling, left legweakness, urinary retention, and a back nodule. MRI showeddestructive bone lesions in the L4 and L5 vertebrae with aleft-sided lumbar paraspinal soft tissue mass extending intothe spinal cord and retroperitoneal region. He underwentintralesional tumor debulking of what was confirmed to bean extraskeletal myxoid chondrosarcoma; L4 and L5 partialcorpectomies, L3-S1 laminectomies and foraminotomies,and pedicle screw instrumentation were performed duringthe same procedure. He later underwent 5 radiation treat-ments. Postoperative MRI demonstrated residual tumor onthe left psoas and iliac muscles extending to the left L4-L5neural foramen. He was transferred to our acute inpatientrehabilitation facility. Admission examination was significantfor normal strength in all limbs except for 4/5 right long toeextensors; 1/5 left hip flexors, knee extensors, and ankledorsiflexors; 3/5 left long toe extensors and ankle plantarflexors. Left lower limb reflexes were absent at the knee andankle compared with 2� in the right lower limb. Sensationwas normal from C2 to S5. He required assistance withmobility and activities of daily living.

Setting: Freestanding rehabilitation hospital.Results: After 1 week of acute inpatient rehabilitation, hisproximal left leg key muscle strength improved by 1 to 2muscle grades. He attained modified independence withambulation using a rolling walker and was discharged homewith his family.Discussion: Extraskeletal myxoid chondrosarcoma is arare, usually indolent, tumor that can metastasize to theperineum, retroperitoneum, and psoas muscles. Femoral pe-ripheral neuropathies have been described, but this is thefirst description of this tumor causing lumbar polyradicu-lopathy.Conclusions: Extraskeletal myxoid chondrosarcoma is arare tumor that can cause polyradiculopathy. After aggressivesurgical and radiation therapy, residual weakness from chon-drosarcoma may improve with comprehensive inpatientrehabilitation.

Poster 32Intravascular Lymphoma Due to PurineAnalogue Use for Inflammatory BowelDisease.Michelle Weiner, DO, MPH (University of Miami,Miami, FL); Kevin L. Dalal, MD.

Disclosures: M. Weiner, None.Patients or Programs: A 63-year-old man with Crohndisease and intravascular lymphoma.Program Description: Patient with a PMHx significantfor Crohn disease presented with acute onset of pain withsudden loss of strength in his lower extremities along withurinary and fecal incontinence. Patient exhibited trace motorstrength and hyporeflexia in bilateral lower extremities anddecreased pinprick and vibratory sensation. Imaging showedincreased hyperintensity in the central cord, starting at T11and progressing distally; there were no intracerebral abnor-malities. CSF analysis revealed a small T-cell population withno diagnostic immuno-phenotypic abnormalities or oligo-clonal bands. All stains and cultures were negative. The initialdiagnosis was that of spinal cord infarct versus transversemyelitis. The patient showed some functional improvementafter undergoing a course of inpatient rehabilitation andtreatment with steroids. Patient was maintained on a pre-prandial opiate regimen to slow bowel motility as well as6-mercaptopurine to treat Crohn.Setting: Tertiary academic medical center inpatient reha-bilitation unit.Results: During the ensuing months, the patient’s neuro-logic status fluctuated. The patient eventually developedacute onset of left upper extremity weakness, left centralfacial paralysis and word-finding difficulty. Imaging revealedabnormal signal density from T1-3 on the right side of thecord. Brain imaging showed a large lesion in the right pre-central gyrus with multiple tiny enhancing foci. The differ-ential included inflammatory processes such as vasculitis,

S21PM&R Vol. 2, Iss. 9S, 2010