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      <h1 class="highwire-cite-title" id="page-title">Malignant Transformation of a Lipomyelocele into a Rhabdomyosarcoma?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.M. O'Connell</span>, <span class="highwire-citation-author" data-delta="1">D. Allcutt</span>, <span class="highwire-citation-author" data-delta="2">F. Brett</span> and <span class="highwire-citation-author" data-delta="3">S. Ryan</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2008,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">29 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">434-435; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A0924 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-7929--6402003634" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.M. O'Connell </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.M.%2BO%27Connell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=O%27Connell%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.M.%2BO%2527Connell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D. Allcutt </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BAllcutt%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Allcutt%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.%2BAllcutt%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">F. Brett </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BBrett%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brett%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AF.%2BBrett%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S. Ryan </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BRyan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ryan%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BRyan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><p id="p-1"><strong>SUMMARY:</strong> We report the unusual transformation of a lipomyelocele to a rhabdomyosarcoma in a 3-year-old boy. A lipomyelocele is not considered pre-malignant, but the possibility of developing such a tumor may represent another reason for close neurological follow-up in patients with spinal dysraphism.</p></div><p id="p-2">Alipomyelocele is an intraspinal lipoma that is tightly attached to the dorsal surface of an open spinal cord.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> The spinal cord remains within the spinal canal unlike a lipomyelomeningocele, in which the thecal sac herniates through the spina bifida. Lipomyeloceles are associated with tethering of the cord but not with malignancy.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup></p><div class="section" id="sec-1"><h2>Case Report</h2><p id="p-3">A spinal sonography was performed on the first day of life in a full-term neonate with a complex hemangioma over the sacrum (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>). This showed the spinal cord ending in a sacral lipoma. The diagnosis of a lipomyelocele was confirmed by MR imaging at 3 months of age (<a id="xref-fig-2-1" class="xref-fig" href="#F2">Fig 2</a>). The baby was managed conservatively with frequent neurosurgical assessment. At 3 years of age, he presented with an unwillingness to walk and general malaise. He had developed a large sacral bulge with a superimposed hematoma. Spinal MR imaging demonstrated a new large mass arising from the lipoma and distal spinal cord within the sacral canal (<a id="xref-fig-3-1" class="xref-fig" href="#F3">Fig 3<em>A</em></a>). There was surface enhancement of the cord (<a id="xref-fig-3-2" class="xref-fig" href="#F3">Fig 3<em>B</em></a>) and brain stem (<a id="xref-fig-3-3" class="xref-fig" href="#F3">Fig 3<em>C</em></a>) consistent with meningeal seeding of the tumor. These findings were confirmed at surgery, and pathologic examination of the partly excised tumor revealed a rhabdomyosarcoma. Histology showed a pleomorphic malignant spindle cell tumor (<a id="xref-fig-4-1" class="xref-fig" href="#F4">Fig 4</a>) positive for muscle markers.</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Photograph of a complex ulcerating hemangioma over the sacrum in a full-term neonate on day 1." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-592539923" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Photograph of a complex ulcerating hemangioma over the sacrum in a full-term neonate on day 1.&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F1.medium.gif" width="202" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F1.medium.gif" width="202" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/25173" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label"><strong>Fig 1.</strong></span> <p id="p-10" class="first-child">Photograph of a complex ulcerating hemangioma over the sacrum in a full-term neonate on day 1.</p><div class="sb-div caption-clear"></div></div></div><div id="F2" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F2.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Sagittal T1-weighted MR image obtained at 3 months confirms the sonographic finding of the tethered spinal cord (arrowhead) ending in a lipomyelocele (arrow)." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-592539923" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Sagittal T1-weighted MR image obtained at 3 months confirms the sonographic finding of the tethered spinal cord (arrowhead) ending in a lipomyelocele (arrow).&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 2." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F2.medium.gif" width="245" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 2." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F2.medium.gif" width="245" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F2.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 2." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F2.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/25126" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption"><span class="fig-label"><strong>Fig 2.</strong></span> <p id="p-11" class="first-child">Sagittal T1-weighted MR image obtained at 3 months confirms the sonographic finding of the tethered spinal cord (<em>arrowhead</em>) ending in a lipomyelocele (<em>arrow</em>).</p><div class="sb-div caption-clear"></div></div></div><div id="F3" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F3.large.jpg?width=800&amp;height=600&amp;carousel=1" title="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." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-592539923" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;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.&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 3." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F3.medium.gif" width="440" height="244"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 3." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F3.medium.gif" width="440" height="244"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F3.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 3." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F3.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/25105" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption"><span class="fig-label"><strong>Fig 3.</strong></span> <p id="p-12" class="first-child"><em>A</em>, Sagittal T1-weighted MR image at 3 years shows a new large homogeneous mass of low signal intensity (<em>arrow</em>), apparently arising from the lipomyelocele and distal spinal cord within the spinal canal. <em>B</em>, Postcontrast T1-weighted sagittal MR image shows multiple foci (<em>arrowheads</em>) of high signal intensity in the distal thoracic and lumbar spinal cord consistent with metastatic seeding. <em>C</em>, Sagittal postcontrast T1-weighted MR image demonstrates multiple foci (<em>arrowheads</em>) of high signal intensity in the brain stem and cervical and upper thoracic spinal cord, consistent with metastatic seeding.</p><div class="sb-div caption-clear"></div></div></div><div id="F4" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F4.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Resection of this sacral mass revealed a pleomorphic malignant spindle cell tumor at pathology, consistent with a rhabdomyosarcoma (hematoxylin-eosin)." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-592539923" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Resection of this sacral mass revealed a pleomorphic malignant spindle cell tumor at pathology, consistent with a rhabdomyosarcoma (hematoxylin-eosin).&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 4." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F4.medium.gif" width="440" height="330"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 4." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F4.medium.gif" width="440" height="330"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F4.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 4." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/29/3/434/F4.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/25084" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption"><span class="fig-label"><strong>Fig 4.</strong></span> <p id="p-13" class="first-child">Resection of this sacral mass revealed a pleomorphic malignant spindle cell tumor at pathology, consistent with a rhabdomyosarcoma (hematoxylin-eosin).</p><div class="sb-div caption-clear"></div></div></div></div><div class="section" id="sec-2"><h2>Discussion</h2><p id="p-4">The clinical finding of sacrococcygeal cutaneous stigmata, such as that seen in this baby, has been clearly linked with occult spinal dysraphism. Screening spinal sonography is indicated in these babies, and positive findings can be confirmed by MR imaging. Management is usually conservative. Follow-up assessments are focused on the detection of any possible evidence of neurologic complications of the tethered cord and, in particular, of any sign of neurologic deterioration. Such findings may be indications for surgical untethering of the cord and resection of the lipoma.</p><p id="p-5">The possibility of development of tumors in neural tube defects has been described.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>–<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a></sup> Lipomyeloceles are not, however, considered premalignant conditions. To our knowledge, the development of a rhabdomyosarcoma within a lipomyelocele has not been previously described. It has, however, been described originating from the central nervous system (CNS). There are no skeletal muscle cells in a lipomyelocele, but it is tightly attached to the dorsal aspect of the open spinal cord.</p><p id="p-6">Primary intracranial rhabdomyosarcoma is a rare tumor in infancy and childhood, which is found in various locations in the CNS.<sup><a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a></sup> The clinical course worsens rapidly, and the final outcome is poor, with a median survival time of 8–10 months.<sup><a id="xref-ref-7-2" class="xref-bibr" href="#ref-7">7</a></sup> Invasion of the meninges, spontaneous intratumoral bleeding, spinal leptomeningeal CSF spreading of tumor cells, and early recurrence of the mass are the distinctive features of rhabdomyosarcoma.<sup><a id="xref-ref-7-3" class="xref-bibr" href="#ref-7">7</a></sup></p><p id="p-7">Intracranial rhabdomyosarcoma has also been described in association with subdural hematoma. The authors propose the possibility of sarcoma development secondary to chronic inflammation and proliferation in subdural collection.<sup><a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a></sup> The coexistence in this instance seems coincidental, however, and subdural hematoma was known to be secondary to a fall.</p><p id="p-8">The development of a rhabdomyosarcoma in this case report is likely embryonal. Although originating from a benign lesion such as a lipomyelocele has not been described previously, to our knowledge, unlike CNS origin, it may represent a very rare transformation.</p><p id="p-9">The possibility of development of such a tumor, however rare, presents another reason for close neurologic follow-up of children with spinal dysraphism. It emphasizes the importance of early neuroimaging of the spinal canal when any new neurologic signs or symptoms develop.</p></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.1"><div class="cit-metadata"><cite>Unsinn KM, Geley T, Freund MC, et al. <strong>US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases.</strong> <span class="cit-source">Radiographics</span> <span class="cit-pub-date">2000</span>;<span class="cit-vol">20</span>:<span class="cit-fpage">923</span>–38</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10903684&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.2" data-doi="10.1016/j.ejrad.2003.10.015"><div class="cit-metadata"><cite>Rossi A. <strong>Imaging in spine and spinal cord malformations.</strong> <span class="cit-source">Eur J Radiol</span> <span class="cit-pub-date">2004</span>;<span class="cit-vol">50</span>:<span class="cit-fpage">177</span>–200</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.ejrad.2003.10.015&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15081131&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.3" data-doi="10.1086/301615"><div class="cit-metadata"><cite>Little J. <strong>Childhood cancer and neural tube defects.</strong> <span class="cit-source">Am J Hum Genet</span> <span class="cit-pub-date">1997</span>;<span class="cit-vol">61</span>:<span class="cit-fpage">1204</span>–05</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1086/301615&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9345109&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-29.3.434.4"><div class="cit-metadata"><cite>Freyer DR, Hutchinson RJ, McKeever PE. <strong>Primary primitive neuroectodermal tumor of the spinal cord associated with neural tube defect.</strong> <span class="cit-source">Pediatr Neurosci</span> <span class="cit-pub-date">1989</span>;<span class="cit-vol">15</span>:<span class="cit-fpage">181</span>–87</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=2562067&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-29.3.434.5"><div class="cit-metadata"><cite>Thorp RH. <strong>Carcinoma associated with myelomeningocele: case report.</strong> <span class="cit-source">J Neurosurg</span> <span class="cit-pub-date">1967</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">446</span>–48</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=4862501&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6 in text" id="ref-6">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.6" data-doi="10.1097/00007632-200212010-00019"><div class="cit-metadata"><cite>Kimura S, Kawaguchi S, Kikuchi K, et al. <strong>Rhabdomyosarcoma arising from a dormant dumbbell ganglioneuroma of the lumbar spine: a case report.</strong> <span class="cit-source">Spine</span> <span class="cit-pub-date">2002</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">E513</span>–17</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1097/00007632-200212010-00019&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12461409&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7 in text" id="ref-7">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.7" data-doi="10.1007/BF00271028"><div class="cit-metadata"><cite>Tomei G, Grimoldi N, Masini B, et al. <strong>Primary intracranial rhabdomyosarcoma: report of two cases.</strong> <span class="cit-source">Childs Nerv Syst</span> <span class="cit-pub-date">2004</span>;<span class="cit-vol">5</span>:<span class="cit-fpage">246</span>–49</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/BF00271028&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-other" id="cit-29.3.434.8"><div class="cit-metadata"><cite>Nejat F, Keshavarzi S, Kalaghchi B, et al. <strong>Chronic subdural hematoma associated with subdural rhabdomyosarcoma: case report.</strong> <span class="cit-source">Neurosurgery</span> <span class="cit-pub-date">2007</span>;<span class="cit-vol">60</span>:<span class="cit-fpage">E774</span>–75, discussion E775</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=17415183&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F3%2F434.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="history-list"><li xmlns:hwp="http://schema.highwire.org/Journal" class="received" hwp:start="2007-10-27"><span class="received-label">Received </span>October 27, 2007.</li><li xmlns:hwp="http://schema.highwire.org/Journal" class="accepted" hwp:start="2007-10-31"><span class="accepted-label">Accepted after revision </span>October 31, 2007.</li></ul><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 29</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">March 2008 </div></div>
      
      
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