1
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Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024; 70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection. OBJECTIVE To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA. METHOD A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment. CONCLUSION Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Leonardo Dessesard Olijnyk
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Felix Janelle
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada.
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2
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Carr MT, Pain M, Kay K, Houten JK. Intraspinal cervicothoracic junction chondrosarcoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23755. [PMID: 38437684 PMCID: PMC10916849 DOI: 10.3171/case23755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Chondrosarcoma is an uncommon spinal tumor that can present as an extraskeletal mass. Rarely, these tumors present as dumbbell tumors through the neural foramina, mimicking schwannomas or neurofibromas. OBSERVATIONS A 46-year-old female presented with 2 years of worsening right-arm radiculopathy. Magnetic resonance imaging of the thoracic spine revealed a peripherally enhancing extramedullary mass through the right T1 foramen and compressing the spinal cord. Computed tomography showed the mass to be partially calcified. She underwent C7-T2 laminectomy and C6-T3 posterior instrumented fusion with gross-total resection of an extradural mass. Pathology revealed a grade I chondrosarcoma. Her symptoms improved postoperatively, with some residual right-arm radicular pain. LESSONS Intraspinal extradural dumbbell conventional chondrosarcoma is rare, with only 9 cases, including ours, reported. Patient ages range from 16 to 72 years old, and male sex is more common in these cases. The most common location is the thoracic spine, and our case is the only reported one in the cervicothoracic junction. These tumors often mimic schwannomas on imaging, but chondrosarcoma should remain in the differential diagnosis, because management of these tumors differs. Chondrosarcoma may benefit from more aggressive resection, including en bloc resection, and may require adjuvant radiotherapy.
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Affiliation(s)
- Matthew T Carr
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Margaret Pain
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Kevin Kay
- 2Department of Pathology, Mount Sinai South Nassau, Oceanside, New York
| | - John K Houten
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
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3
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Primary Sarcomas of the Spine: A Systematic Review and Pooled Data Analysis. Clin Spine Surg 2023:01933606-990000000-00125. [PMID: 36823708 DOI: 10.1097/bsd.0000000000001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 12/01/2022] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN A systematic review of the literature and pooled data analysis of treatment outcomes of primary sarcomas of the spine. OBJECTIVE To examine the current literature and treatment options for primary sarcomas of the spine. SUMMARY OF BACKGROUND DATA A paucity of literature exists on treatment outcomes of primary sarcomas of the spine. MATERIALS AND METHODS Two authors searched PubMed to identify articles for review, and a pooled data analysis was performed to determine overall survival for each type of surgical resection on spine sarcomas. RESULTS In total, 1776 articles were identified, and 11 met our inclusion criteria for review. In chondrosarcoma, overall survival was significantly higher with en bloc excision when compared with piecemeal resection (HR for piecemeal resection: 4.11; 95% CI: 2.08-8.15). Subgroup analysis showed that the addition of radiation therapy after piecemeal excision increased overall survival to 60 months from 48 months with piecemeal excision alone. In osteosarcoma, there was no significant difference in overall survival between en bloc and piecemeal resection (HR for piecemeal resection: 1.76; 95% CI: 0.776-3.99). In Ewing's sarcoma, overall survival was significantly higher when a successful en bloc resection was achieved and coupled with chemotherapy and radiation therapy for local control (HR for piecemeal resection: 7.96; 95% CI: 2.12-20.1). Interestingly, when a successful en bloc resection could not be achieved, chemotherapy and radiation therapy alone had significantly higher survival than piecemeal resection (HR for piecemeal resection: 2.63; 95% CI: 1.01-6.84). A significantly higher number of local recurrences were associated with the piecemeal resection group in all types of spine sarcomas. CONCLUSION This review and pooled data seem to favor en bloc excision for local control as the treatment of choice in primary sarcomas of the spine.
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4
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Elmajee M, Osman K, Dermanis A, Duffaydar H, Soon WC, czyz M. A literature Review: The genomic landscape of spinal chondrosarcoma and potential diagnostic, prognostic & therapeutic implications. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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5
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Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Differentiation of Skull Base Chondrosarcomas, Chordomas, and Metastases: Utility of DWI and Dynamic Contrast-Enhanced Perfusion MR Imaging. AJNR Am J Neuroradiol 2022; 43:1325-1332. [PMID: 35953276 PMCID: PMC9451640 DOI: 10.3174/ajnr.a7607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Differentiation of skull base tumors, including chondrosarcomas, chordomas, and metastases, on conventional imaging remains a challenge. We aimed to test the utility of DWI and dynamic contrast-enhanced MR imaging for skull base tumors. MATERIALS AND METHODS Fifty-nine patients with chondrosarcomas, chordomas, or metastases between January 2015 and October 2021 were included in this retrospective study. Pretreatment normalized mean ADC and dynamic contrast-enhanced MR imaging parameters were calculated. The Kruskal-Wallis H test for all tumor types and the Mann-Whitney U test for each pair of tumors were used. RESULTS Fifteen chondrosarcomas (9 men; median age, 62 years), 14 chordomas (6 men; median age, 47 years), and 30 metastases (11 men; median age, 61 years) were included in this study. Fractional plasma volume helped distinguish all 3 tumor types (P = .003, <.001, and <.001, respectively), whereas the normalized mean ADC was useful in distinguishing chondrosarcomas from chordomas and metastases (P < .001 and P < .001, respectively); fractional volume of extracellular space, in distinguishing chondrosarcomas from metastases (P = .02); and forward volume transfer constant, in distinguishing metastases from chondrosarcomas/chondroma (P = .002 and .002, respectively) using the Kruskal-Wallis H test. The diagnostic performances of fractional plasma volume for each pair of tumors showed areas under curve of 0.86-0.99 (95% CI, 0.70-1.0); the forward volume transfer constant differentiated metastases from chondrosarcomas/chordomas with areas under curve of 0.82 and 0.82 (95% CI, 0.67-0.98), respectively; and the normalized mean ADC distinguished chondrosarcomas from chordomas/metastases with areas under curve of 0.96 and 0.95 (95% CI, 0.88-1.0), respectively. CONCLUSIONS DWI and dynamic contrast-enhanced MR imaging sequences can be beneficial for differentiating the 3 common skull base tumors.
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Affiliation(s)
- Y Ota
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - E Liao
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A A Capizzano
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Baba
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (A.B.), Jikei University School of Medicine Ringgold standard institution, Tokyo, Japan
| | - R Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (R.K.), The University of Tokyo Hospital, Tokyo, Japan
| | - M Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (M.K.), Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Ringgold standard institution, Bunkyo-ku, Japan
| | - A Srinivasan
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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6
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Li Y, Yang S, Liu Y, Yang S. Mice with Trp53 and Rb1 deficiency in chondrocytes spontaneously develop chondrosarcoma via overactivation of YAP signaling. Cell Death Dis 2022; 13:570. [PMID: 35760773 PMCID: PMC9237030 DOI: 10.1038/s41419-022-04916-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 01/21/2023]
Abstract
Chondrosarcoma (CHS) is a rare type of soft sarcoma with increased production of cartilage matrix arising from soft bone tissues. Currently, surgical resection is the primary clinical treatment for chondrosarcoma due to the poor response to radiotherapy and chemotherapy. However, the therapeutic effect is not satisfactory due to the higher local recurrence rate. Thus, management and elucidation of the pathological mechanism of chondrosarcoma remain an ongoing challenge, and the development of effective chondrosarcoma mouse models and treatment options are urgently needed. Here, we generated a new transgenic chondrosarcoma model by double conditional deletions of Trp53 and Rb1 in chondrocyte lineage which spontaneously caused spinal chondrosarcoma and lung metastasis. Bioinformatic analysis of the human soft sarcoma database showed that Trp53 and Rb1 genes had higher mutations, reaching up to approximately 33.5% and 8.7%, respectively. Additionally, Trp53 and Rb1 signatures were decreased in the human and mouse chondrosarcoma tissues. Mechanistically, we found that YAP expression and activity were significantly increased in mouse Col2-Cre;Trp53f/f/Rb1f/f chondrosarcoma tissues compared to the adjacent normal cartilage. Knockdown of YAP in primary chondrosarcoma cells significantly inhibited chondrosarcoma proliferation, invasion, and tumorsphere formation. Chondrocyte lineage ablation of YAP delayed chondrosarcoma progression and lung metastasis in Col2-Cre;Trp53f/f/Rb1f/f mice. Moreover, we found that metformin served as a YAP inhibitor, which bound to the activity area of YAP protein, and inhibited chondrosarcoma cell proliferation, migration, invasion, and progression in vitro and significantly suppressed chondrosarcoma formation in vivo. Collectively, this study identifies the inhibition of YAP may be an effective therapeutic strategy for the treatment of chondrosarcoma.
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Affiliation(s)
- Yang Li
- Department of Basic & Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shuting Yang
- Department of Basic & Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yang Liu
- College of Fisheries and Life Science, Dalian Ocean University, 116023, Dalian, China
| | - Shuying Yang
- Department of Basic & Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Center for Innovation & Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- The Penn Center for Musculoskeletal Disorders, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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7
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Pennington Z, Ehresman J, Pittman PD, Ahmed AK, Lubelski D, McCarthy EF, Goodwin CR, Sciubba DM. Chondrosarcoma of the spine: a narrative review. Spine J 2021; 21:2078-2096. [PMID: 33971325 DOI: 10.1016/j.spinee.2021.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
Chondrosarcoma is an uncommon primary bone tumor with an estimated incidence of 0.5 per 100,000 patient-years. Primary chondrosarcoma of the mobile spine and sacrum cumulatively account for less than 20% of all cases, most .commonly causing patients to present with focal pain with or without radiculopathy, or myelopathy secondary to neural element compression. Because of the rarity, patients benefit from multidisciplinary care at academic tertiary-care centers. Current standard-of-care consists of en bloc surgical resection with negative margins; for high grade lesions adjuvant focused radiation with ≥60 gray equivalents is taking an increased role in improving local control. Prognosis is dictated by lesion grade at the time of resection. Several groups have put forth survival calculators and epidemiological evidence suggests prognosis is quite good for lesions receiving R0 resection. Future efforts will be focused on identifying potential chemotherapeutic adjuvants and refining radiation treatments as a means of improving local control.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA 55905; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287.
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ USA 85013.
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC USA 27710
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC USA 27710
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY USA 11030.
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8
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Ipang F, Librianto D, Aprilya D, Prawirodihardjo B. Giant-sized primary clear cell chondrosarcoma of the thoracolumbar spine: A very rare case report. Ann Med Surg (Lond) 2021; 72:103154. [DOI: 10.1016/j.amsu.2021.103154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
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9
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Tu CH, Chiu YP, Ji HR, Chiu CD. Primary osseous chondrosarcoma in the lumbar spine: case report and literature review with analysis. J Int Med Res 2021; 49:3000605211058890. [PMID: 34842480 PMCID: PMC8649472 DOI: 10.1177/03000605211058890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary spinal chondrosarcoma (CS) is rare. Only a few previous case reports have
included a detailed description of the surgical process used to treat the CS. In
addition, a paucity of documentation exists comparing differences in the
outcomes between the approaches in en bloc resection. Here, we present a case of
CS in the lumbar (L) spine treated with two-stage (anterior and posterior
approach) en bloc surgery and analyze the differences between one-stage and
two-stage approaches in the treatment of primary lumbar CS. A 30-year-old male
patient with an L3 vertebral body CS presented with back pain and lower limb
weakness. Lumbar spine magnetic resonance imaging (MRI) showed an L3 vertebral
body tumor with cord and root compression. Two-stage surgery comprising
posterior total laminectomy and transpedicular screw fixation over L2–L4 in the
first stage, with subsequent anterior corpectomy, cage implantation, and
anterior lumbar interbody fusion was performed to achieve total tumor removal
and stabilization. The patient’s symptoms improved postoperatively, with no
recurrence as of the 2-year follow-up. The analysis of previous similar cases
showed that two-stage surgery, compared with one-stage surgery, appears to be
beneficial in lumbar spine multisegment disease, providing a lower recurrence
rate.
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Affiliation(s)
- Chih-Hisu Tu
- Department of Neurosurgery, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,Spine Center, 38020China Medical University Hospital, China Medical University Hospital, Taichung
| | - You-Pen Chiu
- Department of Neurosurgery, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,Spine Center, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,School of Medicine, 38019China Medical University, China Medical University, Taichung.,Graduate Institute of Biomedical Science, 38019China Medical University, China Medical University, Taichung
| | - Hui-Ru Ji
- Department of Neurosurgery, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,Spine Center, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,School of Medicine, 38019China Medical University, China Medical University, Taichung.,Graduate Institute of Biomedical Science, 38019China Medical University, China Medical University, Taichung
| | - Cheng-Di Chiu
- Department of Neurosurgery, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,Spine Center, 38020China Medical University Hospital, China Medical University Hospital, Taichung.,School of Medicine, 38019China Medical University, China Medical University, Taichung.,Graduate Institute of Biomedical Science, 38019China Medical University, China Medical University, Taichung
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10
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Murphy B, Thillainadesan T, Robinson K, Clarke A, Choong P. Case Report: Reconstruction After Anterior Pubic Hemipelvectomy. Front Surg 2021; 8:585600. [PMID: 34095198 PMCID: PMC8177695 DOI: 10.3389/fsurg.2021.585600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
We report on a case of a large atypical cartilaginous tumor of the pelvis and its novel surgical resection with an anterior hemipelvectomy and reconstruction with an iliac crest graft. Surgical intervention is the mainstay treatment of pelvic chondrosarcomas. However, there have been reports of concern regarding preventing pelvic visceral herniation and adequately reconstructing the pelvis. This report is unique within the literature and has yielded good functional outcomes whilst achieving satisfactory surgical margins and minimizing morbidity.
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Affiliation(s)
- Benjamin Murphy
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | | | - Kerian Robinson
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Anita Clarke
- Department of Urology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter Choong
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
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11
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Chondrosarcoma in the body of the C2 vertebral axis. JAAPA 2021; 33:29-31. [PMID: 33109980 DOI: 10.1097/01.jaa.0000718280.57597.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chondrosarcoma, a malignant bone tumor, is rarely encountered in the cervical spine. This article describes a patient whose neck pain and dysphagia were caused by an expansive, destructive lesion with calcification that was located in the body of the axis (C2 vertebra), the first time a chondrosarcoma has been reported in this location.
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12
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Nunna RS, Patel S, Patil SN, Ansari D, Burch TG, Mehta AI, Chapman J, Oskouian RJ. Incidence, Management, and Outcomes of Adult Patients with Spinal Chondrosarcoma in the United States. World Neurosurg 2021; 149:e316-e328. [PMID: 33601078 DOI: 10.1016/j.wneu.2021.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Spinal chondrosarcomas are rare primary malignant neoplasms composed of cartilage-producing cells. They are slow-growing but locally aggressive lesions that have high rates of recurrence and progression after treatment. We provide the largest comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chondrosarcoma using a large, prospectively collected national database. METHODS Patients with diagnosis codes specific for chondrosarcoma of the spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS A total of 1843 individuals were identified with a diagnosis of chondrosarcoma, 82.1% of which were at the sacrum or coccyx and 17.9% at the spine. The mean overall survival of patients in our cohort was 7.91 years. Increased age, larger tumor, dedifferentiated histology, and presence of metastases were associated with worsened overall survival. Regarding management, 77.7% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, among patients who received radiation, those who received higher-dose radiation had significantly improved overall survival compared with those who received lower-dose radiation. CONCLUSIONS Surgical resection significantly improves overall survival in patients with spinal chondrosarcoma. In those patients receiving radiation, those who receive high doses have improved overall survival compared with those who receive lower doses. Further studies into optimal radiation modality and doses are required.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jens Chapman
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA.
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13
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Auger M, Hecht S, Springer CM. Magnetic Resonance Imaging Features of Extradural Spinal Neoplasia in 60 Dogs and Seven Cats. Front Vet Sci 2021; 7:610490. [PMID: 33490136 PMCID: PMC7817889 DOI: 10.3389/fvets.2020.610490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
This retrospective study describes the MRI features of extradural spinal neoplasia in 60 dogs and seven cats to identify potential distinguishing features between tumor classes and individual tumor types within each class. In dogs, mesenchymal tumors were most common (48%), with undifferentiated sarcomas being the predominant tumor type. Round cell neoplasms were second most common (35%), with lymphoma and multiple myeloma/plasma cell tumor comprising the majority of cases. Only two benign tumors were identified. In cats, lymphoma was most common (5/7), with one case of mesenchymal neoplasia and one case of metastatic carcinoma. Despite some overlap, certain imaging features were able to help prioritize differential diagnoses. The combined features that predicted round cell neoplasia (84%) included the preservation of vertebral shape, homogeneous contrast enhancement, and lesion centering on bone. The combined features that predicted mesenchymal neoplasia (73%) included altered vertebral shape, heterogeneous contrast enhancement, and lesion centering on paraspinal soft tissues. Round cell neoplasms were more likely to have cortical sparing, preservation of overall shape, lesion centering on bone, small soft tissue tumor size, and homogeneous contrast enhancement. Both epithelial and mesenchymal neoplasms were more likely to have cortical lysis, a cavitary component to the soft tissue mass and medium to large soft tissue mass size. The findings of this study can aid in prioritizing differential diagnoses in cases of extradural spinal neoplasia in cats and dogs, which can impact case management, but tissue sampling remains the gold standard for definitive diagnosis.
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Affiliation(s)
- Mylène Auger
- Animages, Longueuil, QC, Canada.,Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Cary M Springer
- Research Computing Support, University of Tennessee, Knoxville, TN, United States
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14
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Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y. Inhibition of Autograft Bone Resorption by Antibone Resorptive Agents After Spinal Reconstruction Surgery for Extensive Cervical Chondrosarcoma: A Case Report with a 10-Year Follow-Up. World Neurosurg 2020; 142:239-245. [PMID: 32659359 DOI: 10.1016/j.wneu.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND For the surgical treatment of spinal malignant tumor, spinal reconstruction with bone graft and instrumentation is necessary after tumor resection, but postoperative complications, including grafted bone resorption, may arise. CASE DESCRIPTION A 42-year-old Asian woman presented with neck pain, tumorous masses on the neck, and left arm pain. Magnetic resonance imaging and computed tomography of the cervical spine showed extensive malignant spinal tumor. Histological examination of tumor biopsy revealed grade I chondrosarcoma. Complete resection of the tumor was performed using an anterior-posterior approach, followed by anterior iliac bone grafting and posterior spinal instrumentation. No tumor recurrence was observed on magnetic resonance imaging at final follow-up after 10 years. However, grafted bone resorption was identified immediately after surgery due to stress shielding by robust spinal instrumentation. To inhibit resorption of grafted bone, the bisphosphonate minodronate was administered for 5 years from 3 years postoperatively, before being replaced by denosumab from 8 years postoperatively. After use of these antibone resorptive agents, grafted bone resorption stopped. CONCLUSIONS Anteriorly grafted bone resorption due to stress shielding may occur after reconstructive cervical spine surgery with robust posterior spinal instrumentation. Bisphosphonates and denosumab may be considered to inhibit grafted bone resorption.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Vaidya MM, Shenoy AS, Goel NA. Chondrosarcoma of the dorsal spine - A rare case. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 10:250-253. [PMID: 32089620 PMCID: PMC7008663 DOI: 10.4103/jcvjs.jcvjs_100_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/06/2019] [Indexed: 12/02/2022] Open
Abstract
Chondrosarcomas of the spine are rare tumors and represent <10% of all chondrosarcomas. In the spine, they may arise from vertebral bodies or posterior elements. They may occur in patients ranging from 13 to 78 years of age. Here, we present a case of a 25-year-old female who presented with complaints of lower backache, stiffness in both lower limbs, and tingling sensation in the right lower limb. On examination, both power and sensations were decreased below waist. Magnetic resonance imaging spine revealed an extradural lesion at D5 vertebral body level with severe cord compression. We received the mass in multiple fragments which were grayish-white and firm to hard in consistency. Microscopically, a chondroid tumor was seen with cells arranged in lobules in abundant myxoid matrix. The neoplastic chondrocytes were large in size and had bizarre hyperchromatic nuclei. Few binucleate and multinucleate forms were also seen along with occasional atypical mitoses. There was permeation and destruction of the host bone, and the tumor was seen invading the marrow spaces. Few foci showed high cellularity. No osteoid formation was seen by the tumor. The tumor was diagnosed as Chondrosarcoma – Grade II.
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Affiliation(s)
| | | | - Naina Atul Goel
- Department of Pathology, Seth GSMC, Mumbai, Maharashtra, India
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16
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Kerr DL, Dial BL, Lazarides AL, Catanzano AA, Lane WO, Blazer DG, Brigman BE, Mendoza-Lattes S, Eward WC, Erickson ME. Epidemiologic and survival trends in adult primary bone tumors of the spine. Spine J 2019; 19:1941-1949. [PMID: 31306757 DOI: 10.1016/j.spinee.2019.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Malignant primary spinal tumors are rare making it difficult to perform large studies comparing epidemiologic, survival, and treatment trends. We investigated the largest registry of primary bone tumors, the National Cancer Database (NCDB), to compare epidemiologic and survival trends among these tumors. PURPOSE To use the NCDB to describe current epidemiologic trends, treatment modalities, and overall survival rates in patients with chordomas, osteosarcomas, chondrosarcomas, and Ewing sarcomas of the mobile spine. The secondary objective was to determine prognostic factors that impact overall survival rates. STUDY DESIGN Retrospective study. PATIENT SAMPLE A total of 1,011 patients with primary bone tumors of the spine (377 chordomas, 223 chondrosarcomas, 278 Ewing sarcomas, and 133 osteosarcomas). OUTCOME MEASURES Five-year survival. METHODS We reviewed the records of 1,011 patients in the NCDB from 2004 through 2015 with histologically confirmed primary osteosarcoma, chondrosarcoma, Ewing sarcoma, or chordoma of the spine. Demographic, clinical, and outcomes data were compiled and compared using chi-squared tests and ANOVA. Long-term survival was compared using the Kaplan-Meier method with statistical comparisons based on the log-rank test. Multivariate analysis was performed to determine survival determinants. RESULTS Surgical resection was the primary mode of treatment for chondrosarcoma (90%), chordoma (84%), and osteosarcoma (80%). The treatment for Ewing sarcoma was multimodal involving chemotherapy, radiation therapy, and surgical resection. Five-year survival rates varied significantly with chordomas and chondrosarcomas having the greatest survival (70% and 69%), osteosarcomas having the worse survival (38%), and Ewing having intermediate 5-year survival at 62% (overall log-rank p<.0001). Multivariate analysis demonstrated significantly improved 5-year survival rates with younger age at diagnosis, private insurance status, lower comorbidity score, lower tumor grade, smaller tumor size, surgical resection, and negative surgical margin. Radiation therapy only improved survival for Ewing sarcoma. CONCLUSIONS This study provides the most comprehensive description of the epidemiologic, treatment, and survival trends of primary bone tumors of the mobile spine. Second, patient and tumor characteristics associated with improved 5-year survival were identified using a multivariate model.
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Affiliation(s)
- David L Kerr
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian L Dial
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA.
| | | | - Anthony A Catanzano
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA
| | - Whitney O Lane
- Department of General Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dan G Blazer
- Department of General Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - William C Eward
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA
| | - Melissa E Erickson
- Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA
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Paulino Pereira NR, Janssen SJ, Stoop N, Hartveldt S, Chen YLE, DeLaney TF, Hornicek FJ, Schwab JH. Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma. Global Spine J 2019; 9:743-753. [PMID: 31552156 PMCID: PMC6745645 DOI: 10.1177/2192568219830330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES (1) To assess patient-reported outcomes-physical function, pain, and quality of life-in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status. METHODS Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were-minimally 6 months after surgery-the EuroQol 5 Dimensions (EQ5D), PROMIS-Physical Function, PROMIS-Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients. RESULTS After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate. CONCLUSIONS Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA,Nuno Rui Paulino Pereira, Room 3.946, Yawkey
Building, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Stein J. Janssen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Nicky Stoop
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Stefan Hartveldt
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Yen-Lin E. Chen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Thomas F. DeLaney
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | | | - Joseph H. Schwab
- Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
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Hari A, Kavar B. Rare case of malignant transformation of a solitary spinal osteochondroma into recurrent metastatic chondrosarcoma. J Clin Neurosci 2019; 67:280-288. [DOI: 10.1016/j.jocn.2019.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
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Fukuda A, de Castro Oliveira DL, Fernandes Joaquim A, Amstalden EMI, de Souza Queiroz L, Reis F. Vertebral body chondrosarcoma with metastasis to the scalp. BJR Case Rep 2019; 5:20180037. [PMID: 31131120 PMCID: PMC6519492 DOI: 10.1259/bjrcr.20180037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/02/2018] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
We present a case of a 30-year-old man who had a 3-year history of low back pain.
MRI demonstrated an infiltrative mass, affecting the vertebral body and pedicles
of L4, with some extension to the vertebral canal. There was also tumor invasion
in the inferior vena cava and in the left iliopsoas muscle. The
anatomopathological examination of the resected L4 vertebral body was of a
malignant neoplasia compatible with mesenchymal chondrosarcoma (high
histological grade). About 2 months after surgery, he developed a progressive
bladder incontinence, bilateral leg weakness and severe back pain. A new MRI was
obtained, confirming progression of the disease. An occipital scalp lesion was
detected and biopsy confirmed cutaneous metastasis. Primary malignant bone
tumors are rare but should be ruled out in young patients with persistent low
back pain. We present a case of a confirmed mesenchymal chondrosarcoma affecting
lumbar spine, with MRI and pathological illustrations. Early diagnosis may
improve the chances of local disease control and even cure.
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Affiliation(s)
- Aya Fukuda
- Master Student in Oncology, State University of Campinas, Campinas, Brazil
| | | | | | | | | | - Fabiano Reis
- Department of Radiology, State University of Campinas, Campinas, Brazil
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Champeaux C, Abi-Lahoud G, Larousserie F. An odd and serious "disc bulging"! Neurochirurgie 2019; 65:187-190. [PMID: 31100350 DOI: 10.1016/j.neuchi.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Cauda equina syndrome is a common acute medical condition, usually caused by large degenerative disc herniation or metastatic lumbar disease. We describe a patient who presented with a lesion featuring both discal and tumoral characteristics. CLINICAL PRESENTATION A 41-year-old woman presented with ongoing back pain, progressive lower-limb weakness and sphincter disorder. Magnetic resonance imaging showed a very odd-looking large anterior epidural lesion originating from the L3-L4 space and severely compressing the roots of the cauda equina. Partial surgical decompression was performed in emergency. At a later time, redo surgery was performed to maximize resection, and was unfortunately followed by several complications. After 6 surgical procedures including a ventriculo-peritoneal shunt insertion and intensive rehabilitation, the patient could walk independently with the aid of one crutch. Following collegial review, the diagnosis of low-grade chondrosarcoma of the intervertebral disc was suggested. CONCLUSION We report on a very unusual and therapeutically challenging spinal tumor diagnosed as low-grade chondrosarcoma of discal origin, an entity never previously described.
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Affiliation(s)
- C Champeaux
- Department of neurosurgery, Lariboisière hospital, 75010 Paris, France; Department of neurosurgery, Sainte-Anne hospital, 75014 Paris, France; Department of neurosurgery, NHNN, university college London hospitals, NHS foundation trust, WC1N 3BG London, UK.
| | - G Abi-Lahoud
- Department of neurosurgery, Lariboisière hospital, 75010 Paris, France
| | - F Larousserie
- Département de pathologie, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
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Howell EP, Williamson T, Karikari I, Abd-El-Barr M, Erickson M, Goodwin ML, Reynolds J, Sciubba DM, Goodwin CR. Total en bloc resection of primary and metastatic spine tumors. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:226. [PMID: 31297391 PMCID: PMC6595209 DOI: 10.21037/atm.2019.01.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary and metastatic tumors of the spine represent a significant cause of patient morbidity, and present a management challenge to treating providers. From a neurosurgical standpoint, resection surgery may be warranted in cases of spinal instability, progressive disease, neurological compromise, or intractable symptoms. Removal of a tumor "en bloc" offers a more aggressive modality over more conservative resection techniques. En bloc resection entails the removal of the entirety of a tumor without violation of its capsule, and may offer improved rates of local control and overall survival in appropriately selected patients. Conversely, this technique carries a higher complication rate, and requires a unique set of technical skills as compared to more traditional resection. Here, we describe the technical aspects of en bloc resection, as well as specific indications and considerations when employing this operative technique.
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Affiliation(s)
| | - Theresa Williamson
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Isaac Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Melissa Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Matthew L Goodwin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Abstract
Primary malignant tumors of the spine are rare and mainly include chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal tumor, and osteosarcoma. The final diagnosis is based on the combination of patient age, topographic and histologic features of the tumor, and lesion pattern on computed tomography (CT) and magnetic resonance (MR) imaging. Imaging evaluation includes radiography, CT, bone scintigraphy, and MR imaging. CT is more useful than radiography for evaluating location of the lesion and analyzing bone destruction and matrix, whereas MR has unmatched ability to assess soft tissue extension. This pictorial review provides an overview of the most prevalent primitive malignant tumors of spine.
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23
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Nisson PL, Berger GK, James WS, Hurlbert RJ. Surgical Techniques and Associated Outcomes of Primary Chondrosarcoma of the Spine. World Neurosurg 2018; 119:e32-e45. [PMID: 30026140 DOI: 10.1016/j.wneu.2018.06.189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Only a few case reports and case series exist reporting on primary chondrosarcomas of the spine. The objective of this study was to gain a better understanding of this patient population and surgical techniques used for treatment. METHODS A systematic literature search was performed in January 2018 querying several scientific databases, per PRISMA guidelines. Surgery type was categorized into en bloc, piecemeal excision, or non-en bloc or piecemeal excision. RESULTS In total, 34 records and 3 patients were included in the systematic review, yielding 87 patients with primary chondrosarcoma of the spine. The mean age was 41.5 years, with the tumor most commonly arising in adult patients (90.8%, 79/87); most were male (66.7%, 58/87). Those who underwent piecemeal excision had the highest death rate (56.7%, P ≤ 0.001) and highest rate of recurrence (63.3%, P ≤ 0.001) compared with en bloc and non-en bloc or piecemeal excision. The calculated reduced relative risk (RR) comparing en bloc with the other surgical techniques for recurrence and mortality was 78.8% (RR, 0.21; P ≤ 0.001) and 80.7% (RR, 0.19; P≤ 0.001), respectively. Survival analysis showed patients with a piecemeal excision had 9.4 times hazards ratio for death compared with en bloc (P = 0.001). CONCLUSIONS CS is a rare lesion that most commonly presents in adult male patients. En bloc surgical resection was associated with a significant decrease in recurrence, mortality, and increased survival compared with the other surgical techniques. In addition, any surgical technique that involved entering the tumor capsule showed a significantly greater risk for recurrence and death.
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Affiliation(s)
- Peyton L Nisson
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Garrett K Berger
- College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - R John Hurlbert
- Division of Neurosurgery, Banner University of Arizona Medical Center Tucson, Tucson, Arizona, USA.
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25
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Kurdi M, McGregor S, Hammond R, Siddiqi F, Wehrli B. Primary Clear Cell Chondrosarcoma of Thoracic Spine. Int J Surg Pathol 2016; 25:181-184. [PMID: 27577196 DOI: 10.1177/1066896916666317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clear cell chondrosarcoma is a rare cartilaginous tumor that arises commonly in the epiphyses of the proximal femur or humerus. Spinal involvement is extremely rare, but when present, it most frequently involves the thoracic spine. Clear cell chondrosarcoma is rarely reported in thoracic spine. We report a case of a 70-year-old man with clear cell chondrosarcoma of the T7-8 thoracic spine. Gross en bloc resection of T6-8 vertebral bodies with reconstruction and fusion followed by radiotherapy were performed.
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Affiliation(s)
- Maher Kurdi
- 1 Western University, London, Ontario, Canada.,2 King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia
| | | | | | | | - Bret Wehrli
- 1 Western University, London, Ontario, Canada
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Roynard PFP, Bilderback A, Falzone C, Stefanacci JD, Cherubini GB. Magnetic resonance imaging, treatment and outcome of canine vertebral chondrosarcomas. Six cases. J Small Anim Pract 2016; 57:610-616. [PMID: 27627693 DOI: 10.1111/jsap.12554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 06/19/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To report the clinical presentation, magnetic resonance imaging features, treatments and outcomes of canine vertebral chondrosarcoma. MATERIALS AND METHODS Retrospective review of medical records of dogs with confirmed vertebral chondrosarcoma and magnetic resonance imaging of the lesions, from four different veterinary referral institutions. RESULTS A total of six dogs were included in this report. In all cases, magnetic resonance imaging revealed a lobulated mass involving the dorsal vertebral compartment, markedly hyperintense with few foci of hypointensity on T2-weighted images, iso to hypointense on T1-weighted images with contrast enhancement after gadolinium administration. Intralesional surgical resection was performed in three dogs and medical management in one, two dogs were euthanased and all lesions were submitted for histopathology. Magnetic resonance imaging findings correlated with histological findings of a low tumour grade. Rapid clinical improvement was noted after surgery but two of three dogs had local regrowth. CLINICAL SIGNIFICANCE Chondrosarcomas show local aggressiveness and resistance to conventional radiotherapy and chemotherapy, and so prognosis depends on feasibility of en bloc resection. Magnetic resonance imaging may be helpful in establishing a presumptive diagnosis and prognosis based on the feasibility of surgical resection.
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Affiliation(s)
- P F P Roynard
- Long Island Veterinary Specialists, Plainview, NY, 11803, USA. .,Fipapharm, 76130, Mont-Saint-Aignan, France.
| | - A Bilderback
- Long Island Veterinary Specialists, Plainview, NY, 11803, USA
| | - C Falzone
- Clinica Veterinaria Pedrani, 14-36030, Zugliano (VI), Italy
| | - J D Stefanacci
- Long Island Veterinary Specialists, Plainview, NY, 11803, USA
| | - G B Cherubini
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, CB8 0UH
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Indelicato DJ, Rotondo RL, Begosh-Mayne D, Scarborough MT, Gibbs CP, Morris CG, Mendenhall WM. A Prospective Outcomes Study of Proton Therapy for Chordomas and Chondrosarcomas of the Spine. Int J Radiat Oncol Biol Phys 2016; 95:297-303. [PMID: 27084648 DOI: 10.1016/j.ijrobp.2016.01.057] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effectiveness of definitive or adjuvant external beam proton therapy on survival in patients with chordomas and chondrosarcomas of the spine. METHODS AND MATERIALS Between March 2007 and May 2013, 51 patients with a median age of 58 years (range, 22-83 years) with chordoma (n=34) or chondrosarcomas (n=17) of the sacrum (n=21), the cervical spine (n=20), and the thoracolumbar spine (n=10) were treated with external beam proton therapy to a median dose of 70.2 Gy(RBE) [range, 64.2-75.6 Gy(RBE)] at our institution. Distant metastases, overall survival, cause-specific survival, local control, and disease-free survival were calculated. RESULTS The mean follow-up time was 3.7 years (range, 0.3-7.7 years). Across all time points, 25 patients experienced disease recurrence: 18 local recurrences, 6 local and distant recurrences, and 1 distant metastasis. The 4-year rates of overall survival and cause-specific survival were 72%; disease-free survival was 57%, local control was 58%, and freedom from distant metastases was 86%. The median time to local progression was 1.7 years (range, 0.2-6.0 years), and the median time to distant progression was 1.6 years (range, 0.2-6.0 years). The risk factors for local recurrence were age ≤58 years (62% vs 26%; P=.04) and recurrence after prior surgery (29% vs 81%; P=.01). Secondary cancers developed in 2 patients: B-cell lymphoma 5.5 years after treatment and bladder cancer 2 years after treatment. We observed the following toxicities: sacral soft tissue necrosis requiring surgery (n=2), T1 vertebral fracture requiring fusion surgery (n=1), chronic urinary tract infections (n=1), surgery for necrotic bone cyst (n=1), and grade 2 bilateral radiation nephritis (n=1). CONCLUSION High-dose proton therapy controls more than half of spinal chordomas and chondrosarcomas and compares favorably with historic photon data. Local progression is the dominant mode of treatment failure and may be reduced by treating patients at the time of initial diagnosis. The impact of age is a novel finding of this study.
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Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Dustin Begosh-Mayne
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Mark T Scarborough
- Department of Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida
| | - C Parker Gibbs
- Department of Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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Abstract
STUDY DESIGN An ambispective cohort study. OBJECTIVE The aim of this study was to determine whether the application of the Enneking classification in the management of spinal chondrosarcomas influences local recurrence and survival. SUMMARY OF BACKGROUND DATA Primary spinal chondrosarcomas are rare. Best available evidence is based on small case series, thus making it difficult to determine optimal management and risk factors for local recurrence and survival. METHODS The AOSpine Knowledge Forum Tumor developed a multicenter ambispective database of surgically treated patients with spinal chondrosarcoma. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Tumors were classified according to the Enneking classification. Patients were divided into two cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI). They were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation, and otherwise, they were categorized as EI. RESULTS Between 1987 and 2011, 111 patients (37 female; 74 male) received surgical treatment for a primary spinal chondrosarcoma at a mean age of 47.4 ± 15.8 years. Patients were followed for a median period of 3.1 years (range = 203 d-18.7 yrs). Median survival for the entire cohort was 8.4 years postoperative. After 10 years postoperative, 36 (32%) patients died and 37 (35%) patients suffered a local recurrence. Twenty-three of these 37 patients who suffered a local recurrence died. Sixty (58%) patients received an EA procedure while 44 (42%) received an EI procedure. EI patients had a higher hazard ratio for local recurrence than those who received an EA procedure (P = 0.052). Local recurrence was strongly associated with chondrosarcoma-related death (risk ratio = 3.6, P < 0.010). CONCLUSION This is the largest multicenter cohort of spinal chondrosarcomas. EA surgical management appeared to correlate with a decreased risk of local recurrence, yet no relationship with survival was found. Where possible, surgeons should strive to achieve EA margins to minimize the risk of local recurrence. LEVEL OF EVIDENCE 4.
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29
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Trabeculated thoracic spine lesion with paraparesis. Spine J 2015. [PMID: 26196100 DOI: 10.1016/j.spinee.2015.07.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Goodwin CR, Khattab MH, Sankey EW, Crane GM, McCarthy EF, Sciubba DM. Epithelial-myoepithelial carcinoma metastasis to the thoracic spine. J Clin Neurosci 2015; 24:143-6. [PMID: 26474503 DOI: 10.1016/j.jocn.2015.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 10/22/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a very rare salivary gland malignancy accounting for less than 1% of salivary gland tumors, and classically arises from the parotid gland in females. Spinal cord compression caused by EMC metastasized from the parotid gland has only been described once in the literature to our knowledge. We report the first case of a patient with parotid EMC spinal metastasis undergoing a gross total resection with instrumented fusion. This case illustrates that an en bloc resection with a planned transgression through the spinal canal may be a reasonable option for EMC metastasized to the spine.
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Affiliation(s)
- C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA
| | - Mohamed H Khattab
- Department of Neurosurgery, The Johns Hopkins University, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA
| | - Eric W Sankey
- Department of Neurosurgery, The Johns Hopkins University, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA
| | - Genevieve M Crane
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward F McCarthy
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA.
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Merchant S, Mohiyuddin SMA, Rudrappa S, Deo RP, A S, Menon LR. Cervical chondrosarcoma- rare malignancy: a case report. Indian J Surg Oncol 2014; 5:293-6. [PMID: 25767342 DOI: 10.1007/s13193-014-0350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 08/27/2014] [Indexed: 10/24/2022] Open
Abstract
To highlight an uncommon bone malignancy, which presented to our institute, as a neck swelling in the supraclavicular region. A 30 year old man presented with history of swelling on the left side of neck since 1 year and numbness of left upper limb since 6 months. Magnetic Resonance Imaging of the Cervical spine & MR Angiography showed a 7.4 × 4.6 cm expansile lesion involving transverse process of C5-C7 vertebrae. As the tumour was found to be deep to the phrenic nerve & brachial plexus, a dual approach was used, anteriorly via neck incision and posteriorly via the spine. The tumour was resected & iliac crest grafted along with stabilization of the cervical spine. Patient is disease free and the cervical spine stabilized with normal movements at two and half years follow up. We need to consider tumour arising from the vertebra as a differential diagnosis for any deep seated hard neck swelling in the supraclavicular region. Even low grade malignancy of this region when resected en-bloc will have a good prognosis.
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Affiliation(s)
- Shuaib Merchant
- Department of ENT and Head and Neck Surgery, Sri Devraj Urs Medical College, Tamaka Kolar, 563101 India
| | - S M Azeem Mohiyuddin
- Department of ENT and Head and Neck Surgery, Sri Devraj Urs Medical College, Tamaka Kolar, 563101 India
| | - Satish Rudrappa
- Department of Spine Surgery, Manipal Hospital, Bangalore, 560017 India
| | - R P Deo
- Department of ENT and Head and Neck Surgery, Sri Devraj Urs Medical College, Tamaka Kolar, 563101 India
| | - Sagayaraj A
- Department of ENT and Head and Neck Surgery, Sri Devraj Urs Medical College, Tamaka Kolar, 563101 India
| | - Lakshmi R Menon
- Department of ENT and Head and Neck Surgery, Sri Devraj Urs Medical College, Tamaka Kolar, 563101 India
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Yin H, Zhou W, Meng J, Zhang D, Wu Z, Wang T, Wang J, Wang P, Shi X, Wu S, Zhao J, Xiao J. Prognostic factors of patients with spinal chondrosarcoma: a retrospective analysis of 98 consecutive patients in a single center. Ann Surg Oncol 2014; 21:3572-8. [PMID: 24833099 DOI: 10.1245/s10434-014-3745-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Chondrosarcoma (CHS) in the spine is relatively rare and minimal information has been published in the literature regarding this subject. The objective of our study was to discuss the factors that may affect outcomes of patients with spinal CHS. METHODS Univariate and multivariate analyses were performed to identify prognostic factors for recurrence, distant metastasis, and survival of spinal CHS. T test, χ (2) test and rank sum test were used to analyze a single factor for recurrence and metastasis, while survival rate was estimated using the Kaplan-Meier method. Factors with p values of ≤0.1 were subjected to multivariate analyses by binary logistic regression analyses or Cox regression analyses. p Values of ≤0.05 were considered statistically significant. RESULTS A total of 98 patients with spinal CHS were included in the study. The mean follow-up period was 49.7 months (range 6-178). Recurrence was detected in 42 patients after initial surgery in our center, while distant metastasis and death occurred in 24 and 32 cases, respectively. The statistical analyses suggested that pathology grade III was closely related with distant metastasis which was an independent prognostic factor for overall survival. Total en bloc spondylectomy could significantly decrease the risk of recurrence, distant metastasis, and death of patients with spinal CHS. CONCLUSIONS Total en bloc spondylectomy could significantly decrease the risk of recurrence and distant metastasis, and meanwhile improve overall survival of spinal CHS. Distant metastasis which was closely associated with pathology grade III was an adverse prognostic factor for overall survival of spinal CHS.
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Affiliation(s)
- Huabin Yin
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Chen B, Yang Y, Chen L, Zhou F, Yang H. Unilateral lateral mass fixation of cervical spinal low-grade chondrosarcoma with intralesional resection: A case report. Oncol Lett 2014; 7:1515-1518. [PMID: 24765168 PMCID: PMC3997676 DOI: 10.3892/ol.2014.1956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/11/2014] [Indexed: 12/13/2022] Open
Abstract
In total, ~10% of chondrosarcomas arise from the mobile spine, and these are prone to local recurrence despite being low-grade malignant tumors. Almost all patients will present with pain and a palpable mass in the area of the lesion. For adequate management of the disease, an early diagnosis and careful surgical staging are important. The present study reports a case of cervical spinal low-grade chondrosarcoma in a young female presenting with a slow-growing mass that had not metastasized during a 3-year period. A unilateral lateral mass fixation system of screws and rods was installed following an intralesional resection of the tumor. At present, two years following the surgery, the patient exhibits no neurological deficiency symptoms. Therefore, unilateral fixation presents an effective alternative technique for the treatment of patients with a lesion on the cervical spine.
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Affiliation(s)
- Bo Chen
- Department of Orthopedic Surgery, First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu 215007, P.R. China
| | - Yan Yang
- Department of Orthopedic Surgery, First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu 215007, P.R. China
| | - Liang Chen
- Department of Orthopedic Surgery, First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu 215007, P.R. China
| | - Feng Zhou
- Department of Orthopedic Surgery, First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu 215007, P.R. China
| | - Huilin Yang
- Department of Orthopedic Surgery, First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu 215007, P.R. China
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Ren C, Zeng J, Song Y, Wang X. Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy. Indian J Orthop 2014; 48:216-9. [PMID: 24741146 PMCID: PMC3977380 DOI: 10.4103/0019-5413.128772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chondrosarcomas are uncommon in the spinal column. En bloc excisions with wide margins are of critical importance but not always feasible in spine. We report the outcome in a case of recurrent lumbar vertebral chondrosarcoma treated with marginal resection and iodine-125 seeds placed in the resected tumor bed.
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Affiliation(s)
- Chunpeng Ren
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jiancheng Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China,Address for correspondence: Dr. Jiancheng Zeng, Sichuan Univ, W China Hosp, Dept Orthoped, 37 Guoxue Rd, Chengdu 610041, Peoples R China. E-mail:
| | - Yueming Song
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiandi Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Cho W, Chang UK. Survival and recurrence rate after treatment for primary spinal sarcomas. J Korean Neurosurg Soc 2013; 53:228-34. [PMID: 23826479 PMCID: PMC3698233 DOI: 10.3340/jkns.2013.53.4.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
Objective We have limited understanding on the presentation and survival of primary spinal sarcomas. The survival, recurrence rate, and related prognostic factors were investigated after treatment for primary sarcomas of the spine. Methods Retrospective analysis of medical records and radiological data was done for 29 patients in whom treatment was performed due to primary sarcoma of the spine from 2000 to 2010. As for treatment method, non-radical operation, radiation therapy, and chemotherapy were simultaneously or sequentially combined. Overall survival (OS), progression free survival (PFS), ambulatory function, and pain status were analyzed. In addition, factors affecting survival and recurrence were analyzed : age (≤42 or ≥43), gender, tumor histologic type, lesion location (mobile spine or rigid spine), weakness at diagnosis, pain at diagnosis, ambulation at diagnosis, initial treatment, radiation therapy, kind of irradiation, surgery, chemotherapy and distant metastasis. Results Median OS was 60 months, the recurrence rate was 79.3% and median PFS was 26 months. Patients with distant metastasis showed significantly shorter survival than those without metastasis. No factors were found to be significant relating to recurrence. Prognostic factor associated with walking ability was the presence of weakness at diagnosis. Conclusion Primary spinal sarcomas are difficult to cure and show high recurrence rate. However, the development of new treatment methods is improving survival.
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Affiliation(s)
- Wonik Cho
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
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Dedifferentiated chondrosarcoma of the cervical spine: a case report. World J Surg Oncol 2013; 11:32. [PMID: 23375124 PMCID: PMC3599151 DOI: 10.1186/1477-7819-11-32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/18/2013] [Indexed: 11/10/2022] Open
Abstract
Dedifferentiated chondrosarcoma (DDCS) is a rare and aggressive bone tumor with poor prognosis. Primary DDCS of the mobile spine is extremely rare, particularly in the cervical spine. We herein describe a first case of cervical DDCS in an 81-year-old male presenting with a slowly growing mass. Radiographs showed an expansion of the cortical contour of the C2 lamina and a soft tissue mass with punctate calcification. Magnetic resonance imaging demonstrated a lobulated lesion expanding over the entire lamina and pedicles of C2 with the tumor protuberant to the adjacent soft tissue. A complete tumor resection was performed. Histologically, the majority of the tumor was a low-grade chondrosarcoma component. However, atypical spindle cells that had proliferated in a fascicular pattern with a collagenous stroma, mimicking fibrosarcoma, were focally observed without a transitional zone, and these features confirmed that the tumor was DDCS.
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Kim SW, Kim MS, Jung YJ. Chondrosarcoma apoplexy in thoracic spine. J Korean Neurosurg Soc 2013; 53:46-8. [PMID: 23441034 PMCID: PMC3579082 DOI: 10.3340/jkns.2013.53.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/09/2012] [Accepted: 01/07/2013] [Indexed: 12/02/2022] Open
Abstract
Chondrosarcoma is a very uncommon malignant primary bone tumor, especially, it occurs extremely rare in the spine. A 52-year-old man was admitted to the emergency room with sudden paraplegia. Twelve hours prior to a paraplegic event, he visited an outpatient clinic with discomfort and tenderness around the medial border of the right scapular, and his neurologic status was absolutely intact. Magnetic resonance imaging showed a lobulated soft tissue mass from T3 to T5, which extended to the epidural space. Computed tomography scans showed soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures. Emergent surgery was performed and the lesion was removed. Dark reddish blood and gel-like material were encountered around the dura and posterior arch during the operation. Multiple pulmonary nodules were found on a chest CT scan and a biopsy of one of them had been proven to be a metastasis of chondrosarcoma. The histologic examination showed dedifferentiated chondrosarcoma. The patient's neurologic deficit was improved slowly from ASIA A to ASIA D. Chondrosarcoma in the spine is extremely rare, even more with acute hemorrhage and sudden expansion into the epidural space. We named it chondrosarcoma apoplexy. We should consider the possibility of a hemorrhagic event when the patient's neurologic deficit worsens suddenly with spinal bone tumor.
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Affiliation(s)
- Sang Woo Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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Paidakakos NA, Rovlias A, Rokas E, Theodoropoulos S, Katafygiotis P. Primary clear cell chondrosarcoma of the spine: a case report of a rare entity and a review of the literature. Case Rep Oncol Med 2012; 2012:693137. [PMID: 23091759 PMCID: PMC3474223 DOI: 10.1155/2012/693137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022] Open
Abstract
Chondrosarcoma is the third most common primary malignant bone tumor after osteosarcoma and Ewing's sarcoma. Clear cell chondrosarcoma is a rare subtype variant of chondrosarcoma, most commonly encountered in the proximal part of the femur or humerus. Vertebral involvement is exceedingly rare and shows a predilection for the thoracic spine. We report the case of a woman with clear cell chondrosarcoma of the thoracic spine, which has been surgically excised, and review the pertinent literature (PubMed). Although it has a reasonably benign biological behavior, clear cell chondrosarcoma needs to be treated as a malignancy. The best treatment for spinal chondrosarcoma is surgery. It should be promptly and adequately resected. Gross-total resection should be the ultimate surgical goal. Radiation therapy should also be considered, especially in the case of subtotal resection or inoperable lesions. In conclusion, it is important to keep in mind this entity in the differential diagnosis of spinal tumors, in order to optimize treatment planning. With adequate treatment, local recurrence rates as low as 20% can be achieved.
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Affiliation(s)
- Nikolaos A. Paidakakos
- Department of Neurosurgery, Asclepeion Voulas General Hospital, Vassileos Pavlou 1, Voula, 16673 Athens, Greece
| | - Aristides Rovlias
- Department of Neurosurgery, Asclepeion Voulas General Hospital, Vassileos Pavlou 1, Voula, 16673 Athens, Greece
| | - Evaggelos Rokas
- Department of Neurosurgery, Asclepeion Voulas General Hospital, Vassileos Pavlou 1, Voula, 16673 Athens, Greece
| | - Spyridon Theodoropoulos
- Department of Neurosurgery, Asclepeion Voulas General Hospital, Vassileos Pavlou 1, Voula, 16673 Athens, Greece
| | - Patroklos Katafygiotis
- Department of Pathology, Asclepeion Voulas General Hospital, Vassileos Pavlou 1, Voula, 16673 Athens, Greece
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Shivapathasundram G, Sammons V, Darwish B. Spinal intradural myxoid chondrosarcoma. J Neurosurg Spine 2012; 17:280-4. [DOI: 10.3171/2012.6.spine111089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a rare case of intradural extramedullary spinal chondrosarcoma. This 38-year-old man presented with urinary retention and lower-limb weakness. Magnetic resonance imaging demonstrated a thoracic intradural extramedullary spinal tumor, which was resected. Histopathology revealed a meningeal myxoid chondrosarcoma. Despite adjuvant radiotherapy, the patient had multiple recurrences and metastases and died 18 months following his first surgery. The management of the rare entity of spinal canal chondrosarcoma is discussed.
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Strovski E, Ali R, Graeb DA, Munk PL, Chang SD. Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass. Skeletal Radiol 2012; 41:1319-22. [PMID: 22526879 DOI: 10.1007/s00256-012-1405-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/19/2012] [Accepted: 03/25/2012] [Indexed: 02/02/2023]
Abstract
We report a case of a lumbar spinal osteochondroma that transformed into a large chondrosarcoma in a 39-year-old male who presented with an abdominal mass and back pain. This mass was also associated with a fracture of the stalk, which on cross-sectional imaging mimicked a mass of retroperitoneal origin. The diagnosis of chondrosarcoma transforming from a lumbar osteochondroma became apparent when comparison was made with previous studies.
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Affiliation(s)
- Evgeny Strovski
- Department of Radiology, University of British Columbia, Vancouver Hospital and Health Sciences Centre, 899 West 12th Ave, Vancouver, BC, Canada.
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Primary spinal chondrosarcoma: radiological manifestations with histopathological correlation in eight patients and literature review. Clin Imaging 2012. [PMID: 23206618 DOI: 10.1016/j.clinimag.2012.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to delineate radiological-pathological correlation in primary vertebral chondrosarcoma. METHODS Eight histopathologically confirmed cases were analyzed for pathological and radiological characteristics. RESULTS Magnetic resonance images of three conventional and one clear cell cases showed lobulated or irregular masses with line or septa enhancement. Two conventional lesions showed signal intensity of high water content on T2-weighted images, in which aneurismal bone cysts were confirmed. The myxoid lesion showed a relatively diffuse signal and enhancement. Marked masses were found in the two mesenchymal patients, either dumbbell-like or round-like. CONCLUSION Primary spinal chondrosarcomas have certain radiological findings that may correlate to the pathological subtypes.
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Chang UK, Cho WI, Lee DH, Kim MS, Cho CK, Lee SY, Jeon DG. Stereotactic radiosurgery for primary and metastatic sarcomas involving the spine. J Neurooncol 2012; 107:551-7. [DOI: 10.1007/s11060-011-0777-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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