A 15-year-old male patient presented with a slow progression of painless right shoulder weakness over the previous six weeks. The magnetic resonance imaging revealed right C4–5 foraminal stenosis caused by right foraminal disc protrusion. The needle electromyography and nerve conduction studies revealed acute C5 and/or C6 radiculopathy. Instead of the initial surgical management modalities, we performed a cervical epidural steroid injection at the C4–5 level. From the day after the patient received the cervical epidural steroid injection, his right shoulder motor weakness improved progressively. Two weeks after the procedure, his right shoulder motor function had fully recovered.
Adolescent ; Constriction, Pathologic ; Electromyography ; Humans ; Magnetic Resonance Imaging ; Male ; Needles ; Neural Conduction ; Radiculopathy ; Shoulder

PURPOSE: The prognosis of patients with malignant pheochromocytoma is poor, but the predictive factors are not well understood. We aimed to identify the clinical characteristics predictive of malignancy after initial surgical removal in patients with pheochromocytoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 152 patients diagnosed with pheochromocytoma, including 5 (3.3%) with metastasis at the time of the initial surgical excision and 12 (7.9%) who developed metastasis during follow-up. To determine the factors predictive of malignancy, we compared clinical, radiographical, and urinary chemical findings between patients with benign and malignant disease. Mean follow-up was 41.5 months (range, 0.9-298 months) after surgery. RESULTS: Malignant tumors were significantly larger than benign tumors (11.1+/-4.0 cm vs. 6.2+/-3.4 cm, p<0.001), and postoperative persistence of arterial hypertension was more frequent after removal of malignant than benign tumors (p=0.001). Among the 147 patients without metastatic disease at diagnosis, those who developed metastasis had significantly lower concentrations of urinary catecholamine metabolites per unit of tumor, including vanillylmandelic acid (1.2 vs. 3.7 mg/day/cm, p=0.049), epinephrine (4.5 vs. 168.9 microg/day/cm, p=0.008), and norepinephrine (13.1 vs. 121.8 mg/day/cm, p<0.001). The overall 5-year metastasis-free survival rate was 84.4% and was significantly higher in patients with smaller tumors (< or =5.5 vs. >5.5 cm; 90.6% vs. 81.2%, p=0.025) and higher 24-hour secretion of vanillylmandelic acid (>2.1 vs. < or =2.1 mg/day/cm; 94.9% vs. 70.9%, p=0.019). CONCLUSIONS: Large tumor size (>5.5 cm) and minimally elevated 24-hour urinary vanillylmandelic acid (< or =2.1 mg/day/cm) were significantly associated with a higher probability of a malignant pheochromocytoma portending a lower metastasis-free survival and mandating more rigorous follow-up after surgery.
Adrenal Gland Neoplasms ; Catecholamines ; Epinephrine ; Follow-Up Studies ; Humans ; Hypertension ; Neoplasm Metastasis ; Norepinephrine ; Pheochromocytoma ; Prognosis ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Vanilmandelic Acid