Posted on Authorea 13 May 2021 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.162094962.28264206/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. h anrsle.Ltrh eeoe iiaino ekmvmns netgtosrvae pnlcord spinal and a constipation revealed for . Investigations treated pilocytic movements. was neck confirmed of He histopathology limitation resection, pain. a surgical developed abdominal After he severe mass. Later recurrent resolved. with pain presented the boy old years Three ABSTRACT Qatar Doha, 3050 P.O.Box 66473549 (+974) Mob: 40240487 (+974) Tel: [email protected] Nashwan J. Abdulqadir Mr. author: Qatar Corresponding Doha, Qatar Corporation, Doha, Medical Center, Hamad Research 6. and Qatar Medical Doha, Sidra Center, Department, Research and 5. Medical Qatar Sidra Doha, Unit, Center, Pathology Research Anatomical and 4. Medical Sidra Qatar Department, Doha, Imaging Center, Diagnostic Research 3. and Medical Qatar Sidra Doha, Department, Center, Neurology Research 2. and Medical Sidra Department, Pediatrics 1. Nashwan Report Case A Alassaf Pain: Anood Abdominal with Child Presenting resection, Old Tumor Years surgical Cord Three After Spinal in Tumor mass. Cord cord Spinal resolved. spinal Title: pain Short a the revealed and Investigations constipation for movements. treated was neck He astrocytoma. of pilocytic pain. limitation confirmed abdominal a histopathology severe developed recurrent he with presented Later boy old years Three Abstract 2021 13, May 2 1 Nashwan Abdulqadir and Alassaf Anood Case A Pain: Abdominal Report with Presenting Tumor Cord Spinal aa eia Corporation Medical Center Hamad Research and Medical Sidra 6 1,6 aaA Shami Al Rana , 1 aaA Shami Al Rana , 2 2 ea lRayahi Al Jehan , 1 ea lRayahi Al Jehan , 3 1 ila Mifsud William , 1 ila Mifsud William , 4 hldAl-Kharazi Khalid , 1 hldA Kharazi Al Khalid , 5 buqdrJ. Abdulqadir , 1 , Posted on Authorea 13 May 2021 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.162094962.28264206/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. lnclyteptetwsdigwl uighsflo-pwt onuooia deficits. neurological no with caudal follow-up and his cranial during DISCUSSION edema well cord doing reduced was patient with the decompression Clinically cord 3). tumor significant residual (Figure site nodular as small tumor well with the a tumor to extent spinal cranial the astrocytoma the of pilocytic at resection was near-complete diagnosis revealed MRI histological features. The Post-operative bland the sparse. showed Hence, very areas were with figures positive. both cells Mitotic GFAP 2). in containing (Figure necrosis. diffusely cells density no were of was fibril cells there nuclei low proliferation; neoplastic The with microvascular focal areas matrix. also and was mucoid fibers There variably dense Rosenthal of and texture and processes biphasic cells a multipolar by bipolar characterized cellularity, with moderate areas to fibrillar low spinal of intramedullary a intradural showed used. the Histopathology was of The neuromonitoring resection Intraoperative level. total achieved. gross vertebral was and T10 , tumor . to C5-T5 likely, underwent down less patient perilesional and, and The significant , superiorly showed astrocytoma, junction tumor low-grade The cervico-medullary head included the the 1). diagnosis irregular of differential to (Figure showing MRI necrosis extending lesion of cord normal. edema extension. intramedullary areas were Clinical neck cord thoracic central reflexes well-defined on complaints. and relatively tendon so enhancement new a deep more showed peripheral his and and directions, for tone, done all was power, institution hallucination. neck in motor our and movements of examination, at neck bouts nerve clinic his with cranial neurology of awakening with His limitation pediatric walking, night while marked the unexplained trunk showed in his noted examination evaluated bent also with repeatedly then improved They patient was pain the He movements. that panel, abdominal reported neck The metabolic parents of normal. Both comprehensive also limitation laxative. including were of him (CRP), investigations, dose was awakened abdominal protein high abdomen Laboratory C-reactive and a occasionally given and and neurologic was It pelvis count, normal. Initial the he and blood as of therefore, complete back, constipation. (MRI) movements, reported minutes imaging to his bowel and resonance few attributed infrequent on Magnetic performed The were and from lying abnormalities. symptoms hard no was lasting stiffness. having his revealed child neck episode examinations also as the was his each therapy patient while laxative of with the worse daily evaluation episodes As was for in abdominal It sleep. clinic severe occurring from neurology with hours. periumbilical, pediatric department several as the emergency to was the to to referral pain presented before abdominal healthy, month previously one boy, pain old years three A pain. abdominal recurrent pain. PRESENTATION a of CASE abdominal as and Examples presenting with tumor constipation, manifesting etiologies. cord (functional), spinal processes extra-abdominal pain pediatric and oncological abdominal pain intra-abdominal are like had other causes patients these with differential these gastrointestinal the of reflux-related, pain, of abdominal 25% variety gastroesophageal the Approximately about of a that characteristics estimated pain. the includes is on abdominal It Depending diagnosis of activities. pediatrics. everyday because in their help affected doctors medical that visited seek to children reasons of commonest the 15% of one is pain Abdominal will treatment immediate and unusual prognosis. BACKGROUND tumors with the presenting cord improve children spinal in and of tumor complications recognition cord Early life-threatening spinal prevent of pain. signs abdominal early as for such observe presentations to clinicians urge authors The Message: Clinical Key Keywords: boia an srctm;PlctcAstrocytoma ; pain; Abdominal 2 , 1,2 Pediatric een ehglgtarr aeof case rare a highlight we Herein, Posted on Authorea 13 May 2021 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.162094962.28264206/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. l aagnrtdo nlzddrn hssuyaeicue nti ulse article. published this in included are study interests this Competing during analyzed or generated data All material and data of Availability obtained. was was Committee publication for Ethics consent our The from permission publication additional for no Consent Therefore, report. case a required. describes article The participate to consent and approval Ethics Declarations protein C-reactive CRP: imaging resonance Magnetic MRI: including causes, extra-intestinal etiology, other pain, gastrointestinal Abbreviations investigations, considered. abdominal identifiable minimal be recurrent no should significant with with tumor, a diagnosed night cord is be at spinal there worse can where be and Especially can benign diagnostic. which are advanced pain more warrant abdominal causes of causes many with most of resection, While treatment microsurgical lesions. the is high-grade about evidence or debate current time, recurrent a the same of CONCLUSION by still cases the indicated is in At option There reserved best contrast. being children. the treatment soft-tissue for adjunctive Still, excellent safe has . it these MRI making of diagnosis, radiation for ionizing lacks choice forward it of leaning with modality and the pain abdominal Regarding were with symptoms rather but the pain back of walking. with 10% present while initially than not Fewer 32% did and patient disturbances. Our abnormalities that sphincter gait revealed have or pediatrics weakness. to in limbs muscle noticed astrocytoma upper and 78% cord headache while the spinal nighttime (89%), in of presentation causing cases weakness common 73 down, developed most of lying the review was with a pain 1994, worse back and was 1971 between described France they In pain The in years. even proportion time manifestation. or the higher initial symptoms. months and slightly take the symptoms might a of as onset and in pain the long occur between is interval to diagnosis the Typically, of tend tumors. they slow-growing and are for tumors, account pediatric lesions high-grade of the However, percent is pain fifteen tumors. adults. back cord to regional spinal ten commonly, most only Most comprise stages. tumors years. later low-grade to Fortunately, at months and over diagnosed males evolve presentation. frequently Overall, first to are at tend tumors age. complaint that these of symptoms why years have reason 10 cally the than in- is less either which children affected. cord, nonspecific, in equally spinal frequently are more the females occur in they located however, are neoplasms; neoplasms nervous tumors. central extramedullary. pediatric or all tramedullary of 10% Approximately 6 4 hs anyicueatoyoaadependymoma. and astrocytoma include mainly These 1,5 5 h rwho h pnlcr uosaeso,adsmtm r usually are symptoms and slow, are tumors cord spinal the of growth The 6 3 3 ti siae ht9%o nrmdlaysia odmse r glial are masses cord spinal intramedullary of 90% that estimated is It 3 6 w hrso h ainsrpre iueback diffuse reported patients the of thirds Two 5 l g rusb a eaetdb these by affected be can be groups age All 7 5 ainstypi- Patients Posted on Authorea 13 May 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162094962.28264206/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. otdfile Hosted site. presenting-with-abdominal-pain-a-case-report operative a the extent to cranial caudal Fig1.pdf the and at (b) cranial tumor edema images residual weighted cord file nodular T1 reduced Hosted small enhanced with with gadolinium decompression tumor cord and spinal significant (a) the as T2 of well Sagittal resection complete spine. near the show MRI textured microvascular Post-operative Scale dense Focal 3: C: cells. mostly neoplastic Figure texture. A of loose proportion A: with mitotic low area very lesion. 200 An a B: the bars: showing immunohistochemistry cells. of Ki67 fibrillary D: features bipolar proliferation. and histological irregular, fibres showing the Rosenthal tumors showing with to area The Microphotographs extending edema level. necrosis. 2: weighted cord of vertebral Figure T1 areas perilesional T10 central Significant enhanced to and with gadolinium down enhancement levels and and peripheral vertebral expansile (b) mainly superiorly hypointense T5 T1 junction T1 to (a), cervicomedullary hyperintense, down T2 T2 the C5 intramedullary Sagittal spanning well-defined lesion relatively spine. cord a the demonstrate of (c) astrocytoma. MRI images cord Preoperative spinal 1: pediatric Figure in factors Prognostic Society. Cancer LEGENDS American al. FIGURES the et of JC, Journal Marchal International A, Interdisciplinary Pierre-Kahn Cancer: outcome. E, and Bouffet management presentation, 7. astrocytomas: cord Spinal PR. pe- Cooper neuro-oncology. neoplasms. of JK, spinal correlation Houten Intramedullary Radiologic-pathologic 6. 1, JG. Part Smirniotopolous EJ, neoplasms: Rushing spinal Roentgenology. KA, adolescent Soderlund and AB, diatric Smith 5. intradu- intramedullary, ZL. Gokaslan of Arnautovi´c overview KI, imaging 4. practical A tumors. neoplasia: osseous spinal Pediatric and children. RS. ral, Iyer in abdominal SJ, tumors Menashe of cord 3. presentation spinal unique intramedullary a of management astrocytoma: Neurosurgical neurosurgery. cord KF. Spinal Kothbauer G. Tye 2. M, Strunc S, Lapsia pain. K, Jackson 1. Library. National Qatar REFERENCES the by provided funding Access Open manuscript final Preparation Acknowledgments the Manuscript approved Search, and Literature read Collection, authors Data All AJN: KAK, WIM, JAR, RSH, AAF, contributions Authors’ funded. not was study This interests. competing no Funding have they that declare authors The ailg aereports. case Radiology μ m. vial at available 2007;43(3):222-235. 2000;47(3):219-224. 2012;198(1):34-43. urn rbesi igotcradiology. diagnostic in problems Current https://authorea.com/users/413761/articles/521960-spinal-cord-tumor- 2018;13(1):284-288. pnlCr Tumors. Cord Spinal 4 pigr 2019. Springer; 2013;42(6):249-265. 1998;83(11):2391-2399. mrcnJunlof Journal American ora of Journal Pediatric Posted on Authorea 13 May 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162094962.28264206/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. presenting-with-abdominal-pain-a-case-report Fig3.pdf file Hosted presenting-with-abdominal-pain-a-case-report Fig2.pdf vial at available at available https://authorea.com/users/413761/articles/521960-spinal-cord-tumor- https://authorea.com/users/413761/articles/521960-spinal-cord-tumor- 5