Case Study Series: Langerhans Cell Sarcoma

One of the most amazing patients I’ve treated was an incredibly brave 7-year old girl, who came in to the emergency room with her parents having extreme difficulties walking.

In addition to feeling numb in both of her legs, she had been experiencing chest pains at night for the past month. In search of answers, we ran emergency imaging and found a lesion on her T6 vertebrae with severe spinal cord compression.

This lesion was a cancerous form of Langerhans Cell Sarcoma. This is an incredibly rare disease with only 50 cases of it ever reported worldwide. Without quick treatment, this condition would leave this young girl paralyzed for the rest of her life.

The shaded area of the spine represents the lesion of the T6

We immediately performed an emergency laminectomy on her T5-7 vertebrae. This surgery creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. This is also known as decompression surgery, because the procedure enlarges your spinal canal to relieve pressure on the spinal cord or nerves. We needed to remove the pressure applied on her T6 from the tumor to allow her to move again.

We were able to remove most of the tumor on our first pass, but we later discovered that the tumor had wrapped itself around the spinal cord and eaten through the vertebrae. We did a second procedure that lasted 15 hours to remove the remainder of the tumor.

(A)

(B)

(C)

Shown above in images A and B, we performed a T6 corpectomy and a T4/5 and T7/8 discectomy to remove most of the vertebral body to help take out the tumor and relieve pressure on this young girl’s nerves. Shown in the posterior image C, we inserted titanium screws from her T4-T8 vertebrae to help stabilize her spine. Bone graft from her rib was used to reconstruct the damaged portions of her spine.

After one year, you can see how her bones in her spine began to fuse together.

After the operation, she made a complete neurological recovery and no other lesions were found through imaging. We were able to successfully remove the tumor and stabilize her back, but this young girl still had to undergo chemotherapy to eliminate the Langherans Cell Sarcoma completely. After 12 cycles of chemotherapy and two years of fighting, no presence of the disease was found by biopsy.

Today, this girl has made a full recovery and is officially cancer free!

Improvements to her spine following the procedure