Primary pleomorphic liposarcoma of the thoracic epidural space: case report

BACKGROUND CONTEXT

Pleomorphic liposarcoma (PLS) is a rare malignant soft tissue tumor comprising 5%-15% of liposarcomas and characterized by high malignant potential. To our knowledge only three cases of this entity have been reported in the spine.

PURPOSE

We describe the only reported case of a purely epidural PLS with no macroscopic bone involvement at diagnosis.

STUDY DESIGN/SETTING

A case presenting clinical evidence that PLS may arise from the epidural fat is reported.

METHODS

The clinical presentation, management, and outcome in a case of primary PLS of the thoracic spine, and a review of the literature, are presented.

RESULTS

A 70-year-male presented with sudden onset lower extremity weakness, constipation, and back pain. Magnetic resonance imaging revealed an epidural lesion at T5 with noted mass effect compressing the spinal cord and extension to the T5-T6 foramen. Urgent decompressive laminectomy with gross total resection was performed. Histopathology revealed high-grade PLS. Adjunct radiotherapy was prescribed. The tumor recurred 3 months later. In spite of repeat surgery, additional radiation, and chemotherapy, the patient developed widespread metastases and succumbed to his disease 1 year after treatment began.

CONCLUSIONS

Spinal PLS is a rare entity, but nonetheless may arise from epidural fat and should be considered in the differential diagnosis of primary spinal cord lesions.

Excellent rates of recanalization and good functional outcome after stent-based thrombectomy for acute middle cerebral artery occlusion. Is it time for a paradigm shift?

The natural history of untreated acute middle cerebral artery (MCA) occlusion is poor, with high rates of mortality (5-33%) and severe long-term disability (40-80% of survivors), despite therapy with intravenous tissue plasminogen activator. We analyzed outcomes in 31 consecutive patients with major ischemic stroke due to acute proximal MCA occlusion who were treated at the Hadassah-Hebrew University Medical Center from February 2010 to October 2012 by endovascular means, using the Solitaire stent (Covidien, Irvine, CA, USA) as a thrombectomy device. Patients had a mean age of 63.3±16.2 years (range, 26-92). The admission National Institutes of Health Stroke Scale score was 19.5±4.3 (median 20). Mean time from symptom onset to femoral artery puncture was 3.8±1.1 hours (median 4 hours). Mean time to recanalization was 46.9±11.1 minutes. Successful recanalization by means of stent-based thrombectomy alone was achieved in 90% of cases and reached 100% after combining definitive stent implantation in three patients. There was no arterial rupture or subarachnoid hemorrhage. Hemorrhagic transformation developed in seven patients (23%), but was symptomatic in only one. Post-procedure CT scan or MRI demonstrated >90% sparing of cortex at risk in all patients. Functional outcome at 90 day follow-up was modified Rankin Score 0-2 in 77% of all patients and 88% of patients younger than 80 years. Three patients (10%) died during hospitalization due to mesenteric event, sepsis, or pulmonary embolism. Our experience suggests that stent-based thrombectomy in selected patients for acute MCA occlusions is safe, very effective in terms of arterial recanalization, and associated with improved neurological outcome. If validated by other groups, endovascular treatment may be proposed as the therapy of choice for MCA occlusion.