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Solis W, Youssef AM, Shaw R, Li Y. Spinal intramedullary uterine carcinosarcoma metastasis. BMJ Case Rep 2024; 17:e259268. [PMID: 38417940 PMCID: PMC10900381 DOI: 10.1136/bcr-2023-259268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Intramedullary spinal cord metastases (ISCM) are a rare and challenging manifestation of metastatic cancer that have devastating impacts on the individual's neurological function, survival expectancy and overall quality of life. Given the rarity and poor prognosis, there is a lack of consensus in management. Uterine carcinosarcoma itself is a rare cancer, accounting for less than 3% of all uterine cancers. It carries a poor prognosis, with only one-third of patients surviving beyond 5 years. There are no previous reports of uterine carcinosarcoma metastases to the spinal cord. Here, we present the case of a woman in her late 70s with a uterine carcinosarcoma intramedullary metastasis that was refractory to radiotherapy treatment and responded favourably to surgical debulking.
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Affiliation(s)
- Waldo Solis
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew M Youssef
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Anatomy and Histology, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Richard Shaw
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yingda Li
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Anatomy and Histology, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Jalali S, Renduchintala K, Afiat TP, Pabbathi S. Schwannomas Mimicking Leptomeningeal Spread in the Setting of Breast Cancer: A Case Report. In Vivo 2023; 37:2835-2839. [PMID: 37905625 PMCID: PMC10621423 DOI: 10.21873/invivo.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Breast cancer is currently the most diagnosed cancer globally. For patients who complete breast cancer treatment, developing a survivorship plan is important, including serial history, physical examinations, and annual mammograms to look for recurrence and metastasis. CASE REPORT This is a case report of a 76-year-old female with a history of recurrent breast cancer who presented with lower-back pain and found to have MRI findings initially concerning for intradural extramedullary metastatic disease. Biopsy was later found to be consistent with benign spinal schwannomas. CONCLUSION We present a unique case of spinal masses in the setting of breast cancer initially concerning for leptomeningeal spread, later found to have benign schwannomas that mimicked leptomeningeal spread on imaging. To our knowledge, this is the first reported case of schwannomas mimicking leptomeningeal spread in a patient with a history of recurrent breast cancer. After metastasis is excluded, schwannomas should be considered in the differential of benign spinal lesions.
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Affiliation(s)
- Samuel Jalali
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL, U.S.A.;
| | | | - Thanh-Phuong Afiat
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL, U.S.A
| | - Smitha Pabbathi
- Department of Survivorship, Moffitt Cancer Center, Tampa, FL, U.S.A
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Tan X, He L, Ren J, Zeng B, Jiang L. A Solitary Spinal Cord Metastasis From Lung Cancer Displayed on 18 F-FDG PET/CT. Clin Nucl Med 2022; 47:824-825. [PMID: 35353742 DOI: 10.1097/rlu.0000000000004188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chest CT images were acquired in a 79-year-old man to evaluate a right lung mass revealed by chest radiography. The image findings suggested possible pulmonary malignancy. FDG PET/CT was performed for staging, which displayed not only a hypermetabolic mass in the upper lobe of right lung but also increased FDG uptake of the spinal cord at T11 to T12 level. A lesion corresponding to the hypermetabolic region of the spinal cord was revealed by MRI. The intramedullary spinal cord metastasis from lung squamous cell carcinoma was confirmed through the pathological examination after the spinal cord lesion was resected.
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Affiliation(s)
- Xiaoyue Tan
- From the PET Center, Department of Nuclear Medicine
| | - Li He
- From the PET Center, Department of Nuclear Medicine
| | - Jingyun Ren
- From the PET Center, Department of Nuclear Medicine
| | - Baozhen Zeng
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
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Emmerová R, Engelová J, Vinakurau S, Ondrová B. CNS Tumors - clinical and radiological aspects. Cesk Patol 2022; 58:150-160. [PMID: 36224037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Tumors of the central nervous system (CNS) include primary tumors - itraaxial, growing from brain and spinal cord cells (neuroepithelial tumors) or extraaxial, growing from surrounding structures (brain and spinal cord, nerve sheaths, vascular structures, lymphatic tissue, germ cells, malformations, pituitary glands). Much more often they are located in the intracranial space a solitary or multiple metastatic spread of malignancy originating from another organ (eg lung, breast, malignant melanoma, Grawitzs tumor). The occurrence of metastases of solid tumors is then in the intraaxial or extraaxial region, leptomeningeal or dural. Even morphologically benign tumors with their occurrence in a closed CNS compartment can have malignant behaviour and cause severe slowly developing to acute neurological symptoms, including intracranial hypertension. Primary tumors of the central nervous system present 1-2% of all cancers, with a higher incidence in adults after the age of 60, with a slight predominance in men, with higher mortality in men than in women. About 5% of CNS tumors are hereditary (e.g., Li-Fraumeni syndrome, neurofibromatosis type I, II). The causes of most brain and spinal cord tumors are unclear, the effect of radiation has been definitely demonstrated, there is an increased risk in transplant patients and AIDS (Acquired Immune Deficiency Syndrome) patients, and the potentiating effects of some chemicals and viruses on the development of CNS neoplasms are uncertain. The effectiveness of treatment of brain and spinal cord tumors is influenced by the existence of the so-called hematoencephalic barrier, which protects the brain from the penetration of toxic substances, but at the same time prevents the penetration of most cytostatics to the tumor target. Another obstacle may be the localization of the tumor in areas difficult to access for histological verification (brain stem, optical chiasma) due to the high risk of complications even after stereotactic biopsy. In some cases, in an effort not to cause an irreversible neurological deficit by inconsiderate tissue collection, the sample of histological material can then become inconclusive to tumor cells, i.e., tumor cells are not captured. Last but not least, the radiosensitivity of some brain structures is also limiting, which makes it impossible to apply a higher dose of ionizing radiation to a tumor affecting sensitive tissues or located near of these sensitive tissues. The rapid development of immunohistochemical (IHC) and molecular genetic analysis methods has significantly refined diagnostics and thus theoretically facilitates the choice of the optimal treatment procedure for the individual patient. While advances in modern conformal photon and particle (currently the most frequently proton) radiotherapy, stereotactic radiosurgery has enabled accurately targeted irradiation of the CNS tumor site and at the same time spare the high-risk brain structures, thereby significantly reduce the risk of acute and late neurotoxicity, pharmacotherapy options are still limited. Just molecular-genetic knowledge already provides us with predictive and prognostic information. They should increasingly stratify patients for targeted therapy.
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Dai C, Sun B, Guan S, Wang W, Liu H, Li Y, Zhang J, Kang J. Evolution of a refractory prolactin-secreting pituitary adenoma into a pituitary carcinoma: report of a challenging case and literature review. BMC Endocr Disord 2021; 21:217. [PMID: 34715828 PMCID: PMC8555299 DOI: 10.1186/s12902-021-00874-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pituitary carcinomas (PCs), defined as distant metastases of pituitary neoplasms, are very rare malignancies. Because the clinical presentation of PCs is variable, early diagnosis and management remain challenging. PCs are always refractory to comprehensive treatments, and patients with PCs have extremely poor prognoses. CASE PRESENTATION We describe one case of a prolactin-secreting pituitary adenoma (PA) refractory to conventional therapy that evolved into a PC with intraspinal metastasis. A 34-year-old female was diagnosed with an invasive prolactin-secreting PA in 2009 and was unresponsive to medical treatment with bromocriptine. The tumor was gross totally removed via transsphenoidal surgery (TSS). However, the patient experienced multiple tumor recurrences or regrowth despite comprehensive treatments, including medical therapy, two gamma knife radiosurgeries (GKSs), and four frontal craniotomies. In 2016, she was found to have an intradural extramedullary mass at the level of the fourth lumbar vertebra. The intraspinal lesion was completely resected and was confirmed as a metastatic PC based on histomorphology and immunohistochemical staining. The literature on the diagnosis, molecular pathogenesis, treatment, and prognosis of patients with prolactin-secreting PCs was reviewed. CONCLUSION PCs are very rare neoplasms with variable clinical features and poor prognosis. Most PCs usually arise from aggressive PAs refractory to conventional therapy. There is no reliable marker to identify aggressive PAs with a risk for progression to PCs; thus, it is difficult to diagnose these PCs early until the presence of metastatic lesions. It is still very challenging to manage patients with PCs due to a lack of standardized protocols for diagnosis and treatment. Establishing molecular biomarkers and the pathobiology of PCs could help in the early identification of aggressive PAs most likely to evolve into PCs.
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Affiliation(s)
- Congxin Dai
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Bowen Sun
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shusen Guan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Wang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Honggang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yong Li
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jialiang Zhang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Abstract
ABSTRACT Glioblastoma multiforme is one of the most common malignant types of tumor arising from the central nervous system known for its devastating intracranial progress and dismal prognosis. Macroscopically evident and symptomatic spinal cord metastasis detected with FDG PET/CT imaging is a rare event. We present a rare case of symptomatic diffuse spinal metastases of glioblastoma multiforme in a 25-year-old woman, who has been previously treated surgically with gross tumor resection followed by adjuvant radiotherapy and chemotherapy with temozolomide.
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Affiliation(s)
- Dharmender Malik
- From the Department of Nuclear Medicine and PET/CT, Paras Hospitals, Gurugram, Haryana
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Filizoglu N, Oksuzoglu K, Bozkurt S, Ozguven S, Erdil TY. FDG PET/CT Findings of Extrarenal Wilms Tumor Originating From the Spinal Cord. Clin Nucl Med 2021; 46:86-87. [PMID: 32956124 DOI: 10.1097/rlu.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extrarenal Wilms tumor (ERWT) is an extremely rare neoplasm of childhood. It occurs predominantly in retroperitoneum and pelvic or inguinal region without involvement of the kidneys. Although the importance of FDG PET/CT in Wilms tumor is well known, its use in ERWT is limited. Herein, we present FDG PET/CT findings of a 3-year-old girl with a lumbar mass, which was later diagnosed with ERWT.
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Affiliation(s)
- Nuh Filizoglu
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Kevser Oksuzoglu
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Salih Ozguven
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Tanju Yusuf Erdil
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Abstract
A woman in her late sixties was referred to the orthopaedic clinic with progressive lower limb weakness and gait disturbance. She was known to have breast cancer with pre-existing infiltrative disease in the left brachial plexus. Magnetic resonance imaging of the spine revealed an intramedullary spinal cord metastasis in the lower cervical cord at C6-C7. She underwent surgical excision but died within six weeks of surgery. This rare case of an intramedullary spinal cord metastasis highlights the extremely poor prognosis in this condition as well as the possibility of perineural invasion into the spinal cord from the brachial plexus lesion. A detailed discussion of the literature on intramedullary spinal cord metastases is also presented.
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Affiliation(s)
- N Jayakumar
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - H Ismail
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - S Athar
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
| | - N Ashwood
- University Hospitals of Derby and Burton NHS Foundation Trust, UK
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9
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Grillo A, Capasso R, Petrillo A, De Vita F, Conforti R. An intramedullary "flame" recognized as being an intramedullary spinal cord metastasis from esophageal cancer. J Radiol Case Rep 2019; 13:14-20. [PMID: 31558963 DOI: 10.3941/jrcr.v13i7.3555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intramedullary spinal cord metastases are rarely encountered in patients suffering from extra - central nervous system primary cancer, with only 2 described cases reported in the literature deriving from esophageal cancer. Intramedullary spinal cord metastases may occur at any level of the spinal cord but cervical location is the most frequent. We report the first case of intramedullary metastasis affecting the thoracic spinal cord from esophageal squamous cell carcinoma in a 35-year-old patient.
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Affiliation(s)
- Assunta Grillo
- Department of Radiology & Radiotherapy, Department of Internal & Experimental Medicine 'F Magrassi', University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaella Capasso
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
- Neuroradiology Service, Department of Radiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angelica Petrillo
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renata Conforti
- Neuroradiology Service, Department of Radiology, University of Campania "Luigi Vanvitelli", Naples, Italy
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Koyama K, Takahashi H, Inoue M, Okawa A, Nakajima A, Sonobe M, Akatsu Y, Saito J, Taniguchi S, Yamada M, Yamamoto K, Aoki Y, Furuya T, Koda M, Yamazaki M, Ohtori S, Nakagawa K. Intradural metastasis to the cauda equina found as the initial presentation of breast cancer: a case report. J Med Case Rep 2019; 13:220. [PMID: 31324210 PMCID: PMC6642473 DOI: 10.1186/s13256-019-2155-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intradural extramedullary spinal metastasis is a relatively rare condition. Furthermore, there are few reports with the initial presentation being a neurological symptom from an intradural metastasis. We report a case of a patient with metastasis to the cauda equina from breast cancer found due to neurological symptoms as the initial presentation. CASE PRESENTATION A 76-year-old Japanese woman who was previously healthy presented to our hospital with bilateral severe buttock and lower extremity pain without any history of injury. A solitary intradural cauda equina mass was found by magnetic resonance imaging at the L2/3 level, and we suspected a schwannoma initially. The patient hoped to undergo surgery due to the severe pain. However, the chest computed tomographic scan obtained to assess the patient's general status showed the suspected breast cancer of the left side and a lung metastasis. Hence, we considered the possibility of cauda equina tumor metastatic from the breast cancer. We performed an L1-3 laminectomy and tumor extirpation. The pathology revealed adenocarcinoma. After surgery, she had relief from pain, and her status remained satisfactory until she died 9 months after surgery. CONCLUSIONS It is difficult to clarify whether the cauda equina tumor is benign or malignant based only on Magnetic resonance imaging findings. Clinicians should consider the possibility of metastasis when planning the surgery for intradural cauda equina tumor extirpation.
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Affiliation(s)
- Keita Koyama
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
- Department of Orthopaedic Surgery, Chiba Eastern Medical Center, 3-6-2, Okayamadai, Togane City, Chiba 283-8686 Japan
| | - Akihiko Okawa
- Department of Orthopaedic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2, Tsubakimori, Chuoku, Chiba City, Chiba 260-8606 Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Shinji Taniguchi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Manabu Yamada
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Keiichiro Yamamoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Chiba Eastern Medical Center, 3-6-2, Okayamadai, Togane City, Chiba 283-8686 Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaragi 305-8575 Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaragi 305-8575 Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
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Maranzano E, Trippa F, Pacchiarini D, Chirico L, Basagni ML, Rossi R, Bellavita R, Schiavone C, Italiani M, Muti M. Re-Irradiation of Brain Metastases and Metastatic Spinal Cord Compression: Clinical Practice Suggestions. Tumori 2019; 91:325-30. [PMID: 16277098 DOI: 10.1177/030089160509100408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The recent improvements of therapeutic approaches in oncology have allowed a certain number of patients with advanced disease to survive much longer than in the past. So, the number of cases with brain metastases and metastatic spinal cord compression has increased, as has the possibility of developing a recurrence in areas of the central nervous system already treated with radiotherapy. Clinicians are reluctant to perform re-irradiation of the brain, because of the risk of severe side effects. The tolerance dose for the brain to a single course of radiotherapy is 50–60 Gy in 2 Gy daily fractions. New metastases appear in 22–73% of the cases after whole brain radiotherapy, but the percentage of re-irradiated patients is 3–10%. An accurate selection must be made before giving an indication to re-irradiation. Patients with Karnofsky performance status >70, age <65 years, controlled primary and no extracranial metastases are those with the best prognosis. The absence of extracranial disease was the most significant factor in conditioning survival, and maximum tumor diameter was the only variable associated with an increased risk of unacceptable acute and/or chronic neurotoxicity. Re-treatment of brain metastases can be done with whole brain radiotherapy, stereotactic radiosurgery or fractionated stereotactic radiotherapy. Most patients had no relevant radiation-induced toxicity after a second course of whole brain radiotherapy or stereotactic radiosurgery. There are few data on fractionated stereotactic radiotherapy in the re-irradiation of brain metastases. In general, the incidence of an “in-field” recurrence of spinal metastasis varies from 2.5–11% of cases and can occur 2–40 months after the first radiotherapy cycle. Radiation-induced myelopathy can occur months or years (6 months-7 years) after radiotherapy, and the pathogenesis remains obscure. Higher radiotherapy doses, larger doses per fraction, and previous exposure to radiation could be associated with a higher probability of developing radiation-induced myelopathy. Experimental data indicate that also the total dose of the first and second radiotherapy, interval to re-treatment, length of the irradiated spinal cord, and age of the treated animals influence the risk of radiation-induced myelopathy. An α/β ratio of 1.9–3 Gy could be generally the reference value for fractionated radiotherapy. However, when fraction sizes are up to 5 Gy, the linear-quadratic equation become a less valid model. The early diagnosis of relapse is crucial in conditioning response to re-treatment.
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12
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Land CF, Bowden BD, Morpeth BG, DeVine JG. Intradural extramedullary metastasis: a review of literature and case report. Spinal Cord Ser Cases 2019; 5:41. [PMID: 31632701 PMCID: PMC6786287 DOI: 10.1038/s41394-019-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.
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Affiliation(s)
- Charles F. Land
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - Blake D. Bowden
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - Brice G. Morpeth
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - John G. DeVine
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
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Di Marco A, Rosta L, Campostrini F, Bonetti A, Palazzi M, Garusi G. The Role of Radiation Therapy in the Management of Primary Non-Hodgkin Lymphomas of the Central Nervous System: Clinical Study of 10 Cases. Tumori 2018; 72:565-73. [PMID: 3810863 DOI: 10.1177/030089168607200605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A series of 10 patients with a primary non-Hodgkin lymphoma of the central nervous system were observed and treated by the authors. All were diagnosed after a pathologic examination of the surgical material; the lesions were supratentorial in all cases and unifocal in 9. In every case radiation therapy improved clinical conditions and in most cases even radiologic features of the patients. Four patients were alive and without evidence of disease many months after therapy. Four patients died with a relapse in the central nervous system; 3 of them had disseminated disease at the time of death. Two patients died for an unknown cause. Radiation therapy was performed with 60Co source with 2 opposed portals and the whole brain irradiation technique in all cases but 2. Doses ranged from 35 to 54 Gy. The recent literature on this uncommon disease and the most adequate therapeutic possibilities of radiation therapy and chemotherapy, or both, are discussed.
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Abstract
Metastatic spinal cord compression, diagnosed in 3–7% of cancer patients, is one of the most dreaded complications of metastatic cancer. It is an oncologic emergency, which must be diagnosed early and treated promptly to achieve the best results and avoid progressive pain, paralysis, sensory loss and sphincter incontinence. Patients who are ambulatory at the time of the diagnosis have a higher probability of obtaining good response to treatment and a longer survival. In clinical practice, back pain accompanies metastatic spinal cord compression in most cases, even in patients with no neurologic deficits. Magnetic resonance imaging is the best tool for diagnosing metastatic spinal cord compression and is able to identify spinal cord compression in 32–35% patients with back pain, bone metastases and normal neurologic examination. Moreover, magnetic resonance imaging gives the extension of the lesion, can diagnose other unsuspected clinical metastatic spinal cord compression sites, and is useful for the radiation oncologist in defining the target volume. Radiotherapy is the treatment of choice in most cases, whereas surgery is advised only in selected patients (ie, if stabilization is necessary, if radiotherapy has already been given in the same area, when vertebral body collapse causes bone impingement on the cord or nerve roots, when there are diagnostic doubts, or when computed tomography-guided percutaneous vertebral biopsy cannot be performed). Laminectomy should be abandoned in favor of more aggressive surgery (ie, posterior, anterior, and/or lateral approach, tumor mass resection, and stabilization of the spine). Generally, radiotherapy must be administered 7–10 days after surgery. The optimal radiation schedule has not been defined. However, as recently suggested by some clinical trials, even the hypofractionated radiotherapy regimens are effective and can be used without increasing radiation-induced myelopathy. Moderate doses of dexamethasone should be used in the early phases of therapy. After radiotherapy, spinal recurrence is generally found in sites different from the first compression area. A close post-treatment follow-up is suggested using clinical parameters (pain, motor and sphincter function), and magnetic resonance imaging should be performed only when a second metastatic spinal cord compression and/or myelopathy are clinically suspected.
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Abstract
Fifteen of 146 (10 %) adult patients with non-Hodgkin's lymphoma showed clinical and pathologic evidence of involvement of the central nervous system (CNS); in 6 patients, the CNS lymphoma was present at the onset of disease, in 3 of them it was the only sign detected. In the remaining 9 cases, CNS involvement appeared during the course of systemic disease. In all cases symptoms related to infiltration of the CNS were associated with advanced disease (stage IV); bone marrow or bone involvement was found in 9 patients (60 %). The histologic subtypes were mostly of high-grade malignancy according to the Kiel classification: immunoblastic (3), centroblastic (3), Burkitt type (2), lymphoblastic (1), LP immunocytoma in polymorphic variant (3), unclassifiable (3). The prominent signs and symptoms of CNS lymphoma are listed: the cranial nerve palsies are the most common finding. The principal means of detecting CNS involvement are discussed: cerebrospinal fluid cytology, brain scan and CAT scan were the most useful diagnostic procedures. The reported data allow identification of patients at high risk of CNS lymphoma: this includes histologies of high-grade malignancy, advanced stage of disease, and bone marrow or bone infiltration. Therefore, either intensive systemic chemotherapy or CNS prophylaxis are recommended for patients with high risk of CNS disease.
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Maranzano E, Latini P, Beneventi S, Marafioti L, Piro F, Perrucci E, Lupattelli M. Comparison of two Different Radiotherapy Schedules for Spinal Cord Compression in Prostate Cancer. Tumori 2018; 84:472-7. [PMID: 9824999 DOI: 10.1177/030089169808400407] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To assess the clinical outcome and toxicity of two different radiotherapy (RT) schedules for the management of metastatic spinal cord compression from prostate cancer, we performed a prospective analysis of 44 patients with the complication. Methods Two different RT schedules were adopted, a split-course regimen of 5 Gy x 3, 4 days rest, and then 3 Gy x 5, and a short-course regimen of 8 Gy, 7 days rest, and then 8 Gy. The split-course RT was adopted for all prostate cancer patients referred to our center between 1986 and 1992. Starting in 1993, the short-course RT was added for patients with a poor prognosis (i.e., paresis or paraplegia, low performance status, and/or short life expectation), whereas others still underwent the split-course regimen. So, 27 (61%) patients were treated with the split-course and the other 17 (39%) with the short-course regimen. Medium follow-up was 48 months (range, 6 to 123). Results Back pain total response rate was 82%. Effectiveness of RT on motor and bladder capacity was conditioned by pretreatment status of patients. All 20 (100%) walking cases maintained the function, whereas 11 of 24 (46%) with motor impairment regained the ability. The difference in response rate was statistically significant (P<0.001). All 36 (100%) patients, able to void at presentation preserved the capacity, whereas 3 of 8 (38%) with sphincter dysfunction no longer needed an indwelling catheter. Posttreatment neurologic status was the only factor found to affect survival. Median survival, 9 months for the whole group, was 10 and 2 months for posttreatment walking and nonwalking patients, respectively (10 vs 2 months, P<0.001). Neither presence of other metastases nor RT regimen used (split vs short-course) conditioned response rate, duration of response or survival. Acute or late, severe toxicity was never recorded. No patient complained of spinal cord morbidity. Conclusions Both split-course and short-course RT schedules were effective and without complications. Early diagnosis was the most important prognostic factor, but there was also recovery of function in about half of the patients unable to walk, and about one-third of patients with bladder dysfunction before treatment. Since length of the course of therapy is a factor with an important impact on the patient's quality of life, the short-course RT regimen adopted in the trial merits further investigation.
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Affiliation(s)
- E Maranzano
- Radiation Oncology Center, Policlinico Hospital of Perugia, Italy
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van der Vlist A, Snijders TJ, Stades AME, Spliet WGM, De Vos FYFL. Successful treatment of leptomeningeally metastasised pituitary carcinoma with temozolomide. Neth J Med 2017; 75:451-454. [PMID: 29256415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 69-year-old man presented with leptomeningeally metastasised pituitary carcinoma, rapidly progressing despite previous treatment with resection, radiotherapy and cabergoline. The patient received temozolomide chemotherapy, resulting in a complete clinical, radiological and biochemical response after 14 cycles, which has been maintained since then. This case lends further support to the role of temozolomide in refractory pituitary tumours.
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Affiliation(s)
- A van der Vlist
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Trahair T, Sorrentino S, Russell SJ, Sampaio H, Selek L, Plantaz D, Freycon C, Simon T, Kraal K, Beck-Popovic M, Haupt R, Ash S, De Bernardi B. Spinal Canal Involvement in Neuroblastoma. J Pediatr 2017. [PMID: 28645442 DOI: 10.1016/j.jpeds.2017.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia; School of Women's & Children's Health, University of New South Wales Medicine, Randwick, Australia.
| | - Stefania Sorrentino
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Susan J Russell
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Laurent Selek
- Neurosurgery Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Dominique Plantaz
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Claire Freycon
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Thorsten Simon
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Kathelijne Kraal
- Department Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Maja Beck-Popovic
- Department of Pediatrics, Hematology-Oncology Unit, University Hospital, Lausanne, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Shifra Ash
- The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Bruno De Bernardi
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Arshad HS, Dudekula RA, Niazi M, Malik S, Khaja M. A Rare Case of Sarcomatoid Carcinoma of the Lung with Spine Metastasis, Including a Literature Review. Am J Case Rep 2017; 18:760-765. [PMID: 28684728 PMCID: PMC5510997 DOI: 10.12659/ajcr.904584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sarcomatoid carcinoma is a rare, aggressive, malignant cancer composed of sarcoma and sarcoma-like components, and can occur in different organs such as the thyroid gland, bone, skin, breast, pancreas, liver, urinary tract, and lung. Pulmonary sarcomatoid carcinoma accounts for only a small percentage of lung cancers and has histological variants that include pleomorphic carcinoma, giant cell carcinoma, spindle cell carcinoma, carcinosarcoma, and pulmonary blastoma. CASE REPORT Here, we present a case of sarcomatoid carcinoma in a 63-year-old HIV-positive Hispanic male who presented with back pain, dry cough, and weight loss. A CT scan of his chest showed an ovoid mass in the lower lobe of the left lung, and an MRI of the spine showed a left lateral paraspinal soft tissue mass causing central canal stenosis and mild cord compression. The patient underwent laminectomy and resection of the spinal mass. A transthoracic needle biopsy of the lung and spinal masses had similar histopathology, and were indicative of sarcomatoid carcinoma. CONCLUSIONS We report a rare case of sarcomatoid carcinoma involving both the lung and spinal cord in the same patient. Sarcomatoid carcinomas of the lung have poor prognosis and are aggressive cancers. Moreover, our case also had the co-occurrence of HIV and sarcomatoid carcinoma.
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Affiliation(s)
- Hafiza Sobia Arshad
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, U.S.A
| | - Rizwan Ahmed Dudekula
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, U.S.A
| | - Masooma Niazi
- Division of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, U.S.A
| | - Sandeep Malik
- Division of Hematology and Oncology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, U.S.A
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, U.S.A
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Zimmermann MH, Beckmann G, Jung P, Flentje M. Hypopharyngeal and upper esophageal ulceration after cervical spine radiotherapy concurrent with crizotinib. Strahlenther Onkol 2017; 193:589-592. [PMID: 28444429 DOI: 10.1007/s00066-017-1135-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
Herein, the authors describe the case of a 31-year-old female patient with primary metastatic adenocarcinoma of the lung referred for radiation therapy of newly diagnosed intramedullary spinal cord metastasis at C4/5 and an adjacent osteolytic lesion. Radiotherapy of the cervical spine level C3 to C5, including the whole vertebra, was performed with 30 Gy in 10 fractions. The patient's systemic therapy with crizotinib 250 mg twice daily was continued. After 8 fractions of radiation the patient developed increasing dysphagia. Ulceration of the hypopharynx and the upper esophagus were obvious in esophagoscopy and CT. Hospitalization for analgesia and percutaneous endoscopic gastrostomy (PEG) was required. First oral intake was possible 3 weeks after the onset of symptoms. The early onset, severity, and duration of mucositis seemed highly unusual in this case. A review of the literature failed to identify any reference to increased mucositis after radiation therapy concurrent with crizotinib, although references to such an effect with other tyrosine kinase inhibitors (TKI) were found. Nevertheless, the authors presume that a considerable risk of unexpected interactions exists. When crizotinib and radiotherapy are combined, heightened attention toward intensified reactions seems to be warranted.
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Affiliation(s)
- Marcus H Zimmermann
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Gabriele Beckmann
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Pius Jung
- Department of Pneumonology, Medical Clinic I, University Hospital of Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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Ohba H, Yamaguchi S, Magaki T, Takeda M, Kolakshyapati M, Sadatomo T, Kurisu K. A Case of Holocord Leptomeningeal Dissemination from Cerebellar Hemangioblastoma without von Hippel-Lindau Disease. Hiroshima J Med Sci 2017; 66:7-10. [PMID: 29986122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hemangioblastoma disseminated along leptomeninges from the solitary cranial lesion without von Hippel-Lindau (VHL) disease is a quite rare instance with 23 cases reported in 40 years. We add a new case and discuss these rare instances. A 55-year-old female underwent surgery for total removal of cerebellar hemangioblastoma. Twenty months later, magnetic resonance (MR) images of the spinal cord revealed a tumor compressing the thoracic cord at T3-4 level which was removed en bloc by emergent spinal surgery. However, paraplegia and bowel bladder dysfunction recurred 5 months after the spinal surgery. Spine MR images showed diffuse enhancement of subarachnoid space. Exploratory surgery disclosed that the enhanced lesion was disseminated hemangioblastoma. After whole spinal irradiation, she was transferred to a palliative care hospital. Even after complete removal, possibility of leptomeningeal dissemination demands continuous follow-up. The mechanism of seeding of hemangioblastoma remains unclear, but attention must be paid to avoid spreading tumor cells during surgery because all the disseminated cases had precedent cranial surgery.
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22
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Janssen S, Bartscht T, Rades D. Prognosis of Patients with Metastatic Spinal Cord Compression from Adrenocortical Carcinoma. In Vivo 2016; 30:717-719. [PMID: 27566097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Adrenocortical cancer is a rare aggressive type of cancer. The prognosis is poor, particularly for metastatic disease. This study focused on metastatic spinal cord compression (MSCC) from adrenocortical carcinoma. PATIENTS AND METHODS Data of three patients who received palliative irradiation of MSCC from adrenocortical carcinoma were retrospectively analyzed for motor function, ambulatory status and survival. RESULTS One patient died before completion of radiotherapy. The other two patients died two weeks and four weeks, respectively, following irradiation. In these patients, pre-radiotherapy pain scores were 9 and 10 points. In both patients, partial pain relief was achieved (scores of 5 and 4 points). All three patients were non-ambulatory before irradiation. In assessable patients, motor function remained unchanged following irradiation. CONCLUSION Palliative irradiation resulted in considerable pain relief, whereas motor function did not improve. Considering the extremely poor survival, supportive care alone may be considered if pain relief is achieved without irradiation.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology & Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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23
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Visocchi M, LA Rocca G, D'Ercole M, Conforti G, Roselli R, Lauriola L, Barbagallo GM. Isolated intramedullary cervical spinal cord metastasis from colon cancer: a surgical or medical challenge? J Neurosurg Sci 2016; 60:405-407. [PMID: 25737363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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24
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Janssen S, Bolm L, Käsmann L, Bartscht T, Rades D. Palliative Radiation Therapy for Spinal Cord Compression from Metastatic Soft Tissue Sarcoma. In Vivo 2016; 30:529-531. [PMID: 27381619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
AIM Spinal cord compression (SCC) from metastatic soft tissue sarcoma is a rare condition. Little is known regarding its optimal treatment. It is not clear whether these patients should receive radiation therapy alone or neurosurgery plus radiation therapy. This study focused on outcomes of patients with SCC from soft tissue sarcoma after radiation therapy alone. PATIENTS AND METHODS The effect of radiotherapy on pain relief and motor function and overall survival were evaluated in four patients. RESULTS Complete pain relief was achieved in two (50%) and overall pain relief in three patients (75%). Motor function remained unchanged in all patients. Overall survival rates at three and six months following irradiation were 25% and 25%, respectively. CONCLUSION Radiotherapy alone resulted in high rates of pain relief in patients with SCC from metastatic soft tissue sarcoma. The effect on motor function was less favorable. Upfront neurosurgery is required for improvement of motor deficits.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Louisa Bolm
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology&Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Affiliation(s)
- Rasha Al-Qurainy
- Pembridge Palliative Care Centre-Community Service, St Charles Centre for Health and Wellbeing, London W10 6DZ, UK
| | - Emily Collis
- Camden, Islington ELiPSe and UCLH and HCA Palliative Care Service, London NW1 2PG, UK
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26
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Ravindra VM, Mazur MD, Driscoll M, McEvoy S, Schmidt MH. BRCA2-positive spinal intramedullary ovarian metastatic disease: case report. Spine J 2016; 16:e201-7. [PMID: 26552643 DOI: 10.1016/j.spinee.2015.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread. PURPOSE The authors discuss the management and surgical decision making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature. STUDY DESIGN/SETTING A case report was used. METHODS The authors describe a case of a 59-year-old woman with Breast Cancer gene (BRCA) 2-positive ovarian cancer who developed progressive myelopathy from a T10 to T11 intramedullary metastatic lesion. RESULTS The patient underwent a standard open T10-T11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative magnetic resonance imaging at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease 1 year after surgery. CONCLUSION Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurologic deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meghan Driscoll
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sara McEvoy
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Solenkova AV, Lubnin AY, Imaev AA, Konovalov NA, Tissen TP, Asyutin DS, Dzyubanova NA, Korolishin VA, Martynova MA. [PREDICTING, POSSIBLE WAYS TO REDUCE AND CORRECTION OF MASSIVE INTRAOPERATIVE BLOOD LOSS IN SPINAL TUMOR SURGERY]. Anesteziol Reanimatol 2016; 61:84-90. [PMID: 27468494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The paper discusses the problem ofpredicting, prevention and therapy of massive intraoperative blood loss in patients with metastasis in spine and spinal cord. We analyze 60 surgical cases in last 14 years in our clinic. Amount of blood loss was more that 80% of total blood volume in each case (from 2.5 to 17 liters). Preoperative selective angiography data on intensity of tumor blood supply were essential for blood loss prediction. Simultaneous embolization oftumor during angiography dramatically reduced intraoperative blood loss. Combination of blood saving techniques (preoperative autodonation, acute normovolemic hemodilution and intraoperative cell salvage) led to effective compensation of blood volume deficit and minimizing of allogenic blood transfusion. Plasma-derived and recombinant factors were effective in management of hemostatic disorders associated with massive blood loss.
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Meneses-Medina M, Ceja-Bojorge AC, Perochena-Gonzalez A, Urbina-Ramírez S, de Anda-Gonzalez J, Bourlon MT. Man With Recurring Chordoma and Progressive Disease Despite Radiotherapy and Radical Resection. Oncology (Williston Park) 2016; 30:180-186. [PMID: 26892155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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29
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Nayman A, Özbek S, Temizöz O, Kanat F, Kıvrak AS. Spinal intramedullary metastasis as the first manifestation of lung cancer. Spine J 2015; 15:e9-10. [PMID: 25982434 DOI: 10.1016/j.spinee.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Alaaddin Nayman
- Department of Radiology, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, Selcuklu, Konya, Turkey
| | - Seda Özbek
- Department of Radiology, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, Selcuklu, Konya, Turkey
| | - Osman Temizöz
- Department of Radiology, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, Selcuklu, Konya, Turkey
| | - Fikret Kanat
- Department of Chest Diseases, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, Selcuklu, Konya, Turkey
| | - Ali S Kıvrak
- Department of Radiology, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, Selcuklu, Konya, Turkey
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Ogul H, Ozel L, Polat G, Koltas O, Kantarci M. Massive leptomeningeal dissemination of a low-grade thalamic astrocytoma in an adult patient. Acta Neurol Belg 2015; 115:415-9. [PMID: 25344827 DOI: 10.1007/s13760-014-0379-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, 25240, Erzurum, Turkey,
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Richioud B, Beji H, Pechard M, Sindou M, Chvetzoff G. A Spinal Cord Radiofrequency Destruction. J Vasc Interv Radiol 2015. [PMID: 26210241 DOI: 10.1016/j.jvir.2015.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bertrand Richioud
- Department of Radiology, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France.
| | - Hedi Beji
- Department of Radiology, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
| | - Marie Pechard
- Department of Palliative Care, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
| | - Marc Sindou
- Department of Neurosurgery, Centre Hospitalo-Universitaire, Lyon, France
| | - Gisele Chvetzoff
- Department of Palliative Care, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
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Yao K, Wu B, Xi M, Duan Z, Wang J, Qi X. Distant dissemination of mixed low-grade astroblastoma-arteriovenous malformation after initial operation: a case report. Int J Clin Exp Pathol 2015; 8:7450-7456. [PMID: 26261652 PMCID: PMC4525986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/20/2015] [Indexed: 06/04/2023]
Abstract
We present a rare case of low-grade astroblastoma coexisting with an arteriovenous malformation (AVM) underwent surgery two times in a 38-year-old man. After the first surgery, this case was reported as a mixed low-grade astroblastoma and AVM. The lesion was completely resected surgically along with AVM. The patient underwent postoperative radiotherapy. Twenty months later, MRI showed enhanced lesions in suprasellar, pineal region and multiple small lesions in the spinal cord, whereas completely no recurrent lesion at the primary tumor site. So, the patient rationally underwent surgical removal in suprasellar and pineal region. After the second surgery, this case was diagnosed as a high-grade astroblastoma. Cells from the second surgical specimens showed high MIB-1 index and an increased olig-2 index. In addition, it is not common for low-grade astroblastoma metastasis to suprasellar, pineal region and spine with completely no recurrence at the original primary tumor site. Therefore it is difficult to predict tumor behavior and patient's clinical outcome merely based on histologic features. The important issue is whether the AVM was thought to be the cause of poor progress of this tumor. More cases are needed to confirm this. Classification and histogenesis of this tumor is still debated. Lack of clinicopathological correlation makes the prognosis of this tumor unpredictable. Anyway, we should be very discreet to treat the astroblastoma, even for low-grade astroblastoma.
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Affiliation(s)
- Kun Yao
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
| | - Bin Wu
- Department of Neurosurgery, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Mei Xi
- Department of Neurology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Zejun Duan
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
| | - Jiqiang Wang
- Department of Neurosurgery, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijng, P. R. China
| | - Xueling Qi
- Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical UniversityHaidian District, Beijing, P. R. China
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Sharr MM. Diagnosis of spinal cord and cauda equina metastases. Prog Exp Tumor Res 2015; 29:93-104. [PMID: 4070640 DOI: 10.1159/000411629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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34
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Ongerboer de Visser BW, van Zanten AP, Twijnstra A, Nooyen WJ, Hart AA. Sensitivity and specificity of cerebrospinal fluid biochemical markers of central nervous system metastases. Prog Exp Tumor Res 2015; 29:105-15. [PMID: 3906759 DOI: 10.1159/000411630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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35
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Kim JH, Hyun CL, Han SH. Intramedullary spinal cord metastasis from pancreatic neuroendocrine tumor. World J Gastroenterol 2014; 20:14063-14067. [PMID: 25320547 PMCID: PMC4194593 DOI: 10.3748/wjg.v20.i38.14063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/25/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023] Open
Abstract
Intramedullary spinal cord metastasis (ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor (pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic failure due to tumor progression is the major cause of death in cases of pNET. To date, no report has described a case of ISCM from pNET. Although spinal cord metastasis of a solid tumor is uncommon, it is a critical condition that can cause a potentially irreversible loss of neurologic function. Here, we report the case of a 45-year-old man who presented with leg weakness and voiding difficulty, and was found to have ISCM from pNET. Surgical treatment prevented further neurological deterioration. This is the first case report of ISCM from pNET.
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Satter MR, Henry PT, Khan AI, Chowdhury Q, Hossain M, Kundu RK. Supratentorial glioblastoma multiforme metastasizing to the cervical spinal cord. Mymensingh Med J 2014; 23:806-810. [PMID: 25481607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cases of glioblastoma multiforme (GBM) metastasizing to the leptomeninges or the intramedullary spine are rare and their prognosis are relatively poor. We present a case of supratentorial glioblastoma WHO grade IV which was later diagnosed to have cervical intramedullary metastasis 7 months after the primary surgery.
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Affiliation(s)
- Peter Robson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
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38
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Wang Q, Hu X, Li Z. [Application study of vertebral column metastasis tumor with embedment of ¹²⁵I by CT guide]. Zhonghua Yi Xue Za Zhi 2014; 94:2573-2575. [PMID: 25511486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To discuss the method, safety and effect of embedding ¹²⁵I to Brachytherapy vertebral column metastasis tumor by CT guided. METHODS 31 cases of vertebral column metastasis tumor were treated with percutaneous embedding ¹²⁵I by CT guided. They were observed the preoperative size and contour of lesions and were planed the activity and dosage of ¹²⁵I , the PD (prescribed dose) was 110-140 Gy, and the particle activity was 26.0-29.6 Mbq. CT scanning and therapeutic effect analysis were immediately carried out after operations. We also made CT scanning regularly to analyze the effect. RESULTS 31 cases of vertebral column metastasis tumor were respectively re-examed of CT in 2, 4, 6 and 12 months after operation. We surveyed the local rate, evaluate the easement of pain and observed the tumor. The local response rate of 19 cases with paravertebral mass was 19/19, 19/19, 18/19, 17/19 cases in turn. The probability of odynolysis 31 cases after 2, 4, 6 months therapy was 96.8% (30/31) , 96.8% (30/31) , 90.3% (28/31) , 71.0% (22/31) in turn. 9.68% of 31 cases that was happened significant ossification in the devastated vertebral body. 12 cases appeared skin pigmentation without myelodiastasis or cutaneous ulcer. CONCLUSION The method to treat the vertebral column metastasis tumor of embedding ¹²⁵I by CT guided was simple, reliable and safety.
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Affiliation(s)
- Qifeng Wang
- Department of Radiology of the People's Hospital of Pingyin Count Shandong Province, Jinan 250400, China
| | | | - Zixiang Li
- Department of Interventional Radiology,Affiliated Hospital of Qingdao University, Qingdao 266011, China.
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39
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Bhargava P, Elble RJ. Clinical reasoning: an unusual cause of transverse myelitis? Author response. Neurology 2014; 83:666-667. [PMID: 25254265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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40
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Rafee S, Elamin YY, Cronin K, Brennan S, Osman N. A rare case of nasopharyngeal carcinoma with widespread CNS metastases. Ir Med J 2014; 107:180-181. [PMID: 24988837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Nasopharyngeal cancer is unique among head and neck cancers. Despite definitive treatment, there is a high rate of recurrence, most commonly in the bone, lung or liver. Brain metastases and particularly, leptomeningeal carcinomatosis are extremely rare. We present a case of recurrent nasopharyngeal carcinoma with brain metastases and leptomeningeal carcinomatosis in the absence of local recurrence and systemic metastases.
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41
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Rades D, Weber A, Karstens JH, Schild SE, Bartscht T. Number of extraspinal organs with metastases: a prognostic factor of survival in patients with metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC). Anticancer Res 2014; 34:2503-2507. [PMID: 24778067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM In patients irradiated for MSCC from NSCLC, the number of extraspinal organs involved by metastases was investigated for associations with survival. PATIENTS AND METHODS The data of 131 patients irradiated with 10×3 Gy in two weeks for MSCC were evaluated. The number of involved extraspinal organs plus eight other factors were retrospectively analyzed. RESULTS The 6-month survival rates were 72%, 57%, 20%, and 11% for the involvement of 0, 1, 2, and ≥3 extraspinal organs, respectively (p<0.001). On multivariate analysis, the number of involved extraspinal organs remained significant (risk ratio 1.60; 95% CI 1.28-2.00; p<0.001). Gender (p=0.028), ECOG performance score (p=0.001), histology (p=0.014), ambulatory status (p=0.002), and time to developing motor deficits (p=0.041) were also independent prognostic factors for survival. CONCLUSION The number of extraspinal organs with metastases is an independent prognostic factor for the survival of NSCLC patients presenting with MSCC and should be considered in future studies.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
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Abu-Ghanem S, Sidon E, Shemesh S, Amital A, Ohana N. [Metastatic spinal cord compression: diagnosis and treatment]. Harefuah 2013; 152:720-752. [PMID: 24482996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Metastatic epidural spinal cord compression is a common complication of cancer that can cause pain and potentiaLly irreversible loss of neurologic function. In most cases this syndrome is caused by compression of the thecal sac and the spinal cord by extradural metastatic mass. The most important steps in minimizing the potential neurologic sequelae are early diagnosis and rapid therapeutic intervention. MRI is generally the preferred imaging modality because of its noninvasive ability to study the entire thecal sac. Surgery and radiotherapy are the primary approaches to treat tumor compressing the spinal cord.
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Affiliation(s)
- Sara Abu-Ghanem
- Department of Orthopedic Surgery, Rabin Medical Center (Beiinson Campus), Petah Tikva, Israel
| | - Eliezer Sidon
- Department of Orthopedic Surgery, Rabin Medical Center (Beiinson Campus), Petah Tikva, Israel
| | - Shay Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center (Beiinson Campus), Petah Tikva, Israel
| | - Amir Amital
- Department of Orthopedic Surgery, Rabin Medical Center (Beiinson Campus), Petah Tikva, Israel
| | - Nissim Ohana
- Department of Orthopedic Surgery, Rabin Medical Center (Beiinson Campus), Petah Tikva, Israel
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44
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Itshayek E. [Paradigm shift in the management of metastatic epidural spinal cord compression: the importance of preserving ambulation]. Harefuah 2013; 152:718-752. [PMID: 24482995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy.
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Affiliation(s)
- Eyal Itshayek
- Department of Neurosurgery, Hadassah-Hebrew University Hospital.
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45
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Hudák I, Stefanits J, Kasó G, Botz L, Dóczi T. [Preoperative embolisation of spinal metastases]. Magy Onkol 2013; 57:275-281. [PMID: 24353994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/01/2013] [Indexed: 06/03/2023]
Abstract
In the management of spinal metastases bringing about neurological symptoms and signs, palliative surgical treatment plays an important role. The goals of surgery are preservation of neurological function especially that of the mobility, pain relief and local tumor control. Many of spinal metastases are hypervascularised, accordingly, preoperative embolisation offers logically improvement in technical realisation of surgery by means of reduction of intraoperative profuse bleeding. To prove this working hypothesis a retrospective analysis was performed. Results of preoperative transarterial embolisation of hypervascularised spinal tumours were worked up from 2000 to 2012. By means of 2 case presentations - to our knowledge, first in the Hungarian literature - the techniques of transarterial spinal embolisation of spinal metastases are described. Indications, complications and effect on intraoperative bleeding events of the embolisation procedure in these oncological cases are presented on the basis of literature search and of our own experience. The case analyses, based mainly on qualitative retrospective data, support the notion that histologically known spinal hypervascularised metastases or those found to be hypervascularised by MRI can be treated effectively by means of preoperative superselective embolisation without major risks of morbidity or mortality.
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Affiliation(s)
- István Hudák
- Idegsebészeti Klinika, Pécsi Tudományegyetem, Pécs, Hungary.
| | - János Stefanits
- Idegsebészeti Klinika, Pécsi Tudományegyetem, Pécs, Hungary.
| | - Gábor Kasó
- Idegsebészeti Klinika, Pécsi Tudományegyetem, Pécs, Hungary.
| | - Lajos Botz
- Gyógyszerészeti Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Tamás Dóczi
- Klinikai Idegtudományi Képalkotó Kutatócsoport, MTA-PTE, Pécs, Hungary
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Isono H, Hayakawa N, Inoue A, Onose A. [Three cases of lung cancer presenting with spinal cord paralysis as the initial manifestation-symptom control, nursing care, and coordination of home medical care]. Gan To Kagaku Ryoho 2013; 40 Suppl 2:188-190. [PMID: 24712141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bone metastasis from lung cancer accounts for approximately 30% of all metastatic bone tumors. The median survival time of patients with stage IV lung cancer with bone metastases is 5.5 months and that of patients without bone metastases is 7.5 months. Here, we report 3 cases of spinal cord paralysis. All cases were assessed according to the Tokuhashi score. As the predicted survival time of these patients was < or = 6 months, we opted for conservative treatment. We administered chemotherapy and radiation therapy, ensured symptom control, provided nursing care (prevention of decubitus, position changing, defecation control, rehabilitation, and mental health care), and coordinated home medical care. Patient management was mediated by a multidisciplinary medical team. However, all 3 patients were unable to return home and died in the hospital within 1-2 months after the onset of spinal cord paralysis. Spinal metastases can be expected not only in patients with lung cancer but also in patients with other types of carcinomas. Early diagnosis and treatment and accurate prognosis prediction are essential. Rapid responses and cooperation from experts are required, and increased awareness regarding spinal metastases among health professionals is essential.
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Park J, Chung SW, Kim KT, Cho DC, Hwang JH, Sung JK, Lee D. Intramedullary spinal cord metastasis in renal cell carcinoma: a case report of the surgical experience. J Korean Med Sci 2013; 28:1253-6. [PMID: 23960457 PMCID: PMC3744718 DOI: 10.3346/jkms.2013.28.8.1253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/03/2013] [Indexed: 12/18/2022] Open
Abstract
Intramedullary spinal cord metastasis (ISCM) from renal cell carcinoma (RCC) is rare manifestation and most of them are treated by adjuvant treatment modalities like radiotherapy. Despite the radio-resistance of RCC itself, focal radiotherapy has been preferred as the first-line treatment modality of ISCM from RCC and only a few cases underwent surgical treatment. We describe a case of ISCM from RCC, which underwent surgical excision and pathologically confirmed. A 44-yr-old man was presented with rapid deterioration of motor weakness during focal radiotherapy for ISCM from RCC. After the surgery for removal of the tumor mass and spinal cord decompression, his motor power was dramatically improved to ambulate by himself. We report the first published Korean case of ISCM from RCC confirmed pathologically and describe our surgical experience and his clinical characteristics.
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Affiliation(s)
- Jeongill Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seok-Won Chung
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Joo-Kyung Sung
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Dakeun Lee
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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48
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Belaid I, Jlassi H, Debbiche G, Rais H, Ben Ayed F. [Lung adenocarcinoma with intramedullary spinal cord metastasis: a case report and review of the literature]. Rev Pneumol Clin 2013; 69:149-151. [PMID: 23582264 DOI: 10.1016/j.pneumo.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 06/02/2023]
Abstract
Intramedullary spinal cord metastases are extremely rare and affect 0.1 to 0.4% of all cancer patients. We report the case of intramedullary metastases in a 42-year-old patient, 12 months after the initial diagnosis of a lung adenocarcinoma. The patient was on third-line chemotherapy for a progressive disease with node and bone metastases. He complained of weakness and difficulty walking. The MRI permitted confirmation of the diagnosis. Corticotherapy was started and the patient underwent radiotherapy. A targeted therapy was indicated. The patient died three months after the initiation of this treatment. The aim of this paper is to report a new case of intramedullary spinal cord metastases from a pulmonary adenocarcinoma, focus on its rarity and diagnostic and therapeutic difficulties through a review of the literature.
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Affiliation(s)
- I Belaid
- Service de carcinologie médicale, institut Salah-Azaiz, faculté de médecine de Tunis, Tunis, Tunisie.
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49
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Hansson K, Gutte H, Idris F. [Glioblastoma multiforme with intra- and extramedullary dissemination to the spinal cord]. Ugeskr Laeger 2013; 175:1118-1119. [PMID: 23651753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Metastases to the spinal cord from glioblastoma multiforme (GBM) are uncommon, but important to have in mind when patients with a history of GBM present with symptoms that do not correlate with the primary disease pattern. We report a rare case, where a male with GBM, six months after tumour excision followed by concomitant radio- and chemotherapy, presented with gait disturbance and unspecific neurological symptoms of the lower right limb. Magnetic resonance imaging of columna totalis revealed both intra- and extramedullary metastases in the spinal cord. The patient died one month later.
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Affiliation(s)
- Karin Hansson
- Radiologisk Afsnit, Diagnostisk Afdeling, Glostrup Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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50
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Quiles Granado AM, Laguillo Sala G, Gómez Roselló E, Remollo Friedemann S, Pedraza Gutiérrez S. [Spinal cord compression due to metastasis from a hepatocarcinoma in an human immunodeficiency virus-positive patient. A propos of a case]. Gastroenterol Hepatol 2013; 36:437-8. [PMID: 23465581 DOI: 10.1016/j.gastrohep.2012.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 11/16/2022]
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