Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.177
Filtrar
1.
J Med Case Rep ; 15(1): 14, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33461603

RESUMO

BACKGROUND: Leiomyosarcomas are rare malignant tumors which originate from smooth muscle cells and very seldom give rise to intracerebral metastases. Nearly all cases of intracranial metastases stem from leiomyosarcomas of the uterus. We present a 61-year-old Caucasian man who developed multiple intracranial and extracranial metastases from leiomyosarcoma of the right forearm, diagnosed and treated 9 years before the current presentation. CASE PRESENTATION: The Caucasian patient presented to the emergency department due to a progressive hemiparesis on the left side. Magnetic resonance imaging scans of the neurocranium showed multiple intracerebral masses with perifocal edema. One of these was located in the right parietal lobe, corresponding to the hemiparesis. The patient underwent microsurgical complete resection of the parietal mass and was subsequently subjected to further radiotherapy. Histopathological studies revealed metastasis of the former leiomyosarcoma. CONCLUSIONS: Leiomyosarcomas represent a rare entity of mesenchymal tumors. Intracerebral metastasis of these tumors is even less frequent. This case shows the importance of long-term follow-up in patients with leiomyosarcoma.


Assuntos
Neoplasias Encefálicas/secundário , Leiomiossarcoma/secundário , Neoplasias de Tecidos Moles/patologia , Neoplasias da Coluna Vertebral/secundário , Neoplasias Gástricas/secundário , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Irradiação Craniana , Antebraço , Humanos , Avaliação de Estado de Karnofsky , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/terapia , Imagem por Ressonância Magnética , Masculino , Melena/etiologia , Metastasectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos , Paresia/etiologia , Antro Pilórico , Radioterapia , Sacro , Neoplasias de Tecidos Moles/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias Gástricas/complicações , Tela Subcutânea , Fatores de Tempo
2.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504522

RESUMO

We report the case of an 84-year-old male patient suffering from a gastrointestinal stromal tumour (GIST) of the rectum who was referred to our ENT (Ear-Nose-Throat) clinic for a rapidly progressive stridor, aphagia and dysphonia. The clinical examination revealed a mass arising from the posterior wall of the pharynx, which obstructed the laryngeal inlet and thus the airway. A metastasis of the GIST was suspected. After completing the investigation with radiological imaging, the patient underwent surgery, which consisted of a tracheostomy to secure the airway and a biopsy of the mass. The pathological examination confirmed the suspected diagnosis of a GIST vertebral metastasis.


Assuntos
Vértebras Cervicais , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Idoso de 80 Anos ou mais , Biópsia , Transtornos de Deglutição/etiologia , Progressão da Doença , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/secundário , Humanos , Masculino , Sons Respiratórios/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Traqueostomia
3.
Clin Nucl Med ; 46(2): 148-150, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315666

RESUMO

ABSTRACT: Vertebral epithelioid hemangioma is a rare vascular tumor composed of the many vessels lined by distinct epithelioid endothelial cells. We present the case of a patient with renal cell cancer (RCC) and suspicious vertebral metastasis presenting with back pain, who was later found to have epithelioid hemangioma. FDG PET/CT demonstrated uptake of FDG not only in RCC, but also in the sixth thoracic vertebral body. The SUVmax of the vertebra was more than twice as high as RCC. This report indicates importance of quantitative assessment of FDG uptake, as well as combined use of MRI.


Assuntos
Carcinoma de Células Renais/patologia , Células Endoteliais/patologia , Fluordesoxiglucose F18 , Hemangioma/diagnóstico por imagem , Neoplasias Renais/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica
4.
Tech Vasc Interv Radiol ; 23(4): 100699, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308579

RESUMO

This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.


Assuntos
Dor nas Costas/cirurgia , Criocirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Neoplasias da Coluna Vertebral/cirurgia , Dor nas Costas/diagnóstico , Criocirurgia/efeitos adversos , Humanos , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(50): e23499, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327288

RESUMO

RATIONALE: Synovial sarcoma (SS) is a soft tissue neoplasm that rarely occurs in the vertebral body and should be considered in the differential diagnosis in patients with SS and vertebral lesions. SS often presents as a painless mass in the spine, which may undergo slow enlargement, resulting in sustained symptoms of neurologic deficit and pain. Due to the difficulty in differentiating between SS from other soft tissue tumors and metastatic tumors, careful histological confirmation is required for definite diagnosis. Furthermore, due to its malignancy, the appropriate treatment procedure for SS should be carefully considered. PATIENT CONCERNS: A 56-year-old female patient had low back pain. Radiological examination revealed bony erosion of the L-2 vertebral body, and no soft tissue mass around the lumbar spine. DIAGNOSIS: Histopathological and immunohistochemical examination revealed SS. INTERVENTIONS: The initial treatment of posterior laminectomy decompression and percutaneous vertebro plasty (PVP) was performed, however, this initial treatment course was inappropriate, but she eventually underwent L-2 complete resection and internal fixation. After the second surgery, she was treated by external beam radiation therapy. OUTCOMES: operation radiotherapy was finally performed. No local recurrence in L-2 vertebral body or distant metastasis was found at 1-year follow up postoperation; the neurologic symptom gradually relieved, and no other symptom was noted. And no local recurrence in L-2 vertebral body and distant metastasis was found in 1 year follow up postoperation. LESSONS: Solitary spinal SS is extremely rare. Early surgery for total resection and adjuvant radiotherapy/chemotherapy should be emphasized.


Assuntos
Vértebras Lombares , Sarcoma Sinovial/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Laminectomia , Dor Lombar/etiologia , Pessoa de Meia-Idade , Sarcoma Sinovial/complicações , Sarcoma Sinovial/diagnóstico por imagem , Sarcoma Sinovial/terapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia
6.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
7.
Kyobu Geka ; 73(10): 829-833, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130774

RESUMO

While cases of surgical resection for primary lung cancers are increasing, lung cancer requiring vertebrectomy is rare. A high complication rate and recurrence rate have been reported after surgical resection for lung cancer with vertebral invasion. However, select patients who achieve complete resection after effective preoperative chemoradiotherapy show a better survival rate than others. Preoperative computed tomography and magnetic resonance imaging are necessary to consider surgical strategies and how to resect and reconstruct the vertebral body and chest wall with a clear margin before surgery. A 3-dimensional imaging or simulation model is useful for such ends. Several surgical approaches have been developed, such as the transmanubrial, posterior, posterolateral, or the combination thereof. Proper vertebrectomy( total, hemi, part of a vertebra, or only the transverse process of a vertebra) and reconstruction approaches should be decided in conjunction with orthopedic surgeons. While evidence is lacking, establishing proper surgical indications and developing effective strategies to achieve complete resection with a clear margin are the most critical points in lung cancer requiring vertebrectomy.


Assuntos
Neoplasias Pulmonares , Neoplasias da Coluna Vertebral , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Pneumonectomia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(44): e22937, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126359

RESUMO

RATIONALE: Surgical treatment of spinal hepatocellular carcinoma metastasis after Liver transplantation (LT) is a clinical challenge. We herein report the clinical outcomes of the first case of a patient with T11 from hepatocellular carcinoma metastasis after systemic chemotherapy following LT combined with mesenteric resection and colectomy, who was successfully treated with En Bloc spondylectomy. PATIENT CONCERNS: The patient with HCC was a 40-year-old man, who had received LT combined with mesenteric resection and colectomy 15 months before. His main symptom was progressive back pain because of T11 metastasis. PET examinations showed a solitary metastasis at T11 without recurrence in the liver and metastasis in the other organs. DIAGNOSIS: The patient was diagnosed with the T11 vertebra HCC metastasis after LT combined with resection of HCC mesenteric metastasis and colon metastasis. INTERVENTIONS: Five cycles of systemic chemotherapy following LT were performed for preventing HCC metastases. However, the right abdominal wall metastasis was found 9 months after LT, followed by T11 metastases thereafter. Immediate resection of the right abdominal wall metastasis was achieved. En Bloc spondylectomy of T11 vertebra was chosen as a treatment for metastasis to T11. After T11 surgery, the patient showed obvious pain relief. However, At 3 months after T11 surgery, a grafted liver metastasis and multiple nodules metastasis in the greater omentum region were revealed with CT imaging, At 5 months after T11 surgery, multiple lung metastases were discovered by MRI. The patient was performed 5 cycles of chemotherapy, 3 times of infusion of iodine [131I] meximab and 3 times of TACE after T11 surgery. Multiple bone metastases were treated with radiotherapy. OUTCOMES: The patient died 29 months after LT combined with mesenteric resection and colectomy because of recurrence in the liver and metastasis in the lung. LESSONS: En Bloc spondylectomy may be a therapeutic choice for patients with progression after systemic chemotherapy for the solitary spinal metastases after LT combined with mesenteric resection and colectomy, which has a survival benefit without local recurrence at the surgical site. immunosuppressant after LT may result in worse immune function, which leads to HCC more prone to recurrence and bone metastasis.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias do Colo/secundário , Neoplasias Hepáticas/patologia , Transplante de Fígado/efeitos adversos , Neoplasias Peritoneais/secundário , Neoplasias da Coluna Vertebral/secundário , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/tratamento farmacológico , Colectomia , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Mesentério/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiografia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas
9.
Medicine (Baltimore) ; 99(42): e22604, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080695

RESUMO

We examined the therapeutic effects of argon-helium cryoablation guided by computed tomography (CT) in the treatment of sacral chordoma.This is a retrospective study. CT-guided argon-helium cryoablation was used to treat 9 sacral chordoma patients at our centers between January 2016 and June 2019. We collected data on treatment response and success. Data from long-term follow-up of treatment outcomes were also assessed.All patients were treated successfully according to the indicated technical parameters. There were no reports of procedure-related complications from any of the patients. Complete response (CR) was also achieved in all patients. Six patients (66.7%) achieved initial CR after 1 treatment session and 3 patients (33.3%) achieved secondary CR after 2 treatment sessions. The chordoma-related symptoms improved significantly in all patients after treatment. The mean visual analogue scale score improved from 7.3 before treatment to 4.2 after treatment (P < .001). The mean function score improved from 3.2 before treatment to 1.4 after treatment (P < .001). The median length of follow-up for all patients was 33 months (range: 6-46 months). All patients were alive during the follow-up. Two (22.2%) patients experienced local recurrence (LR) at 6 and 9 months after treatment, respectively. These patients had revised treatment with trans-arterial embolism (n = 1) or repeat ablation (n = 1). The median progression-free survival was 36.8 months.Treatment of sacral chordoma with CT-guided argon-helium cryoablation is effective and offers a potentially beneficial therapeutic alternative for patients with the condition.


Assuntos
Cordoma/cirurgia , Criocirurgia , Radiografia Intervencionista , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Cordoma/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
J Cancer Res Ther ; 16(4): 878-883, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930134

RESUMO

Aim of Study: The goal of this research was to investigate if application of optimized imaging parameters, recommended in literature, would be effective in producing the image quality required for treatment planning of spinal radiation fields with metallic implants. Materials and Methods: CT images from an anthropomorphic torso phantom with and without spinal implants were acquired using different imaging protocols: raising kVp and mAs, reducing the pitch and applying an extended CT scale (ECTS) technique. Profiles of CT number (CT#) were produced using DICOM data of each image. The effect of artifact on dose calculation accuracy was investigated using the image data in the absence of implant as a reference and the recommended electron density tolerance levels (Δρe). Results: Raising the kVp was the only method that produced improvement to some degree in CT# in artifact regions. Application of ECTS improved CT# values only for metal. Conclusions: Although raising the kVp was effective in reducing metallic artifact, the significance of this effect on Δρe values in corrected images depends on the required tolerance for treatment planning dose calculation accuracy. ECTS method was only successful in correcting the CT number range in the metal. Although, application of ECTS method did not have any effect on artifact regions, its use is necessary in order to improve delineation of metal and accuracy of attenuation calculations in metal, provided that the treatment planning system can use an extended CT# calibration curve. Also, for Monte Carlo calculations using patient's images, ECTS-post-processed-CT images improve dose calculation accuracy for impure metals.


Assuntos
Metais , Imagens de Fantasmas , Próteses e Implantes , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Artefatos , Humanos , Método de Monte Carlo , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X/instrumentação
11.
Bull Cancer ; 107(10): 1019-1023, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32972763

RESUMO

In this review, we report a case of a bone's metastatic breast cancer in Malian patient treated by chemotherapy in whom SRAS-COV-2's diagnosis was made 9days after the onset gastrointestinal symptoms. Patient quickly died before any COVID-19's treatment. According to the poor outcomes of cancer patients with COVID-19, authors emphasize to an intensive attention to such patients in order to find the best therapeutic balance between the two pathologies during this pandemic.


Assuntos
Betacoronavirus , Neoplasias da Mama/complicações , Carcinoma Ductal de Mama/secundário , Infecções por Coronavirus/complicações , Diarreia/etiologia , Pandemias , Pneumonia Viral/complicações , Neoplasias da Coluna Vertebral/secundário , Vômito/etiologia , Adulto , Antineoplásicos Fitogênicos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/tratamento farmacológico , Docetaxel/uso terapêutico , Evolução Fatal , Feminino , Infecções por HIV/complicações , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ácido Zoledrônico/uso terapêutico
12.
AJR Am J Roentgenol ; 215(3): 706-712, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755199

RESUMO

OBJECTIVE. The existing literature lacks research into the benefits of initial screening imaging for patients with cerebellar hemangioblastoma. We aimed to evaluate the diagnostic yield of initial screening imaging using abdominal CT and whole-spine MRI in patients with cerebellar hemangioblastoma. MATERIALS AND METHODS. This retrospective study included 117 consecutive patients with histopathologically confirmed, newly diagnosed cerebellar hemangioblastomas at a single tertiary hospital between January 2006 and October 2018. Patients underwent contrast-enhanced abdominal CT, whole-spine MRI, or both to detect abdominal and spinal lesions of von Hippel-Lindau disease. Diagnostic yields and false referral rates for initial screening imaging were determined. RESULTS. After exclusion of six patients who forewent any initial imaging, 111 patients were included (53 men [mean age ± SD, 51 ± 13 years] and 58 women [mean age, 43 ± 16 years]). The diagnostic yield of abdominal CT was 3.8% (4 of 105; 95% CI, 1.1-9.3%), whereas the false referral rate was 1.0% (1 of 105; 95% CI, 0.0-5.2%). For whole-spine MRI, the corresponding values were 5.6% (4 of 71; 95% CI, 1.6-13.8%) and 2.8% (2 of 71; 95% CI, 0.3-9.8%), respectively. The respective diagnostic yields in patients with a single cerebellar hemangioblastoma were both 0% (0 of 98 and 66, respectively). CONCLUSION. For patients with a single cerebellar hemangioblastoma, screening examinations with abdominal CT and whole-spine MRI are unnecessary before the results of genetic testing are available.


Assuntos
Abdome/diagnóstico por imagem , Neoplasias Cerebelares/diagnóstico por imagem , Hemangioblastoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença de von Hippel-Lindau/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
15.
Turk Neurosurg ; 30(4): 632-635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32672344

RESUMO

Spinal meningiomas are rare in the lumbosacral region. The best solution is complete tumor resection. However, how to preserve the patient?s rectum/bladder function after en bloc resection is still a considerable challenge, even without spinopelvic reconstruction. The use of the three-dimensional (3D) printing technique may simplify it. The final step after restoration is the establishment of rigid fixation. The purpose of this article was to present a case of lumbosacral meningiomas treated by en bloc resection, 3D-printed prosthesis reconstruction, and fixation with pedicle screws and cortical bone trajectory screws. A 35-year-old woman has suffered from lumbosacral and two legs pain for two months. During the previous month, she limped, and her strength was 4/5 in both legs. Magnetic resonance imaging (MRI) revealed space-occupying lesions from the lumbar 5 (L5) to sacral 3 (S3) vertebral bodies. The previous biopsy confirmed the lesions were spinal meningiomas. The patient underwent an en bloc resection followed by 3D-printed prosthesis reconstruction and internal fixation with a novel technique. The surgery was successful, and the patient recovered well postoperatively according to follow-up examination. En bloc resection of L5-S3 meningiomas without rectum/bladder function sacrifice is a feasible procedure, and 3D-printed prosthesis provides an alternative method for the reconstruction of the spinopelvic ring. The rigid fixation construct using the novel four-rod technique could develop strong bony fusion.


Assuntos
Fixadores Internos , Região Lombossacral/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Impressão Tridimensional , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Prótese Ancorada no Osso , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Reto/diagnóstico por imagem , Reto/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
16.
Asia Pac J Clin Oncol ; 16(5): e192-e197, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32506805

RESUMO

AIM: To provide guidance for appropriate imaging examinations for diagnosing spinal tumors or tumor-like lesions. METHODS: A total of 121 patients with suspected spinal tumors were included this retrospective study. Each patient underwent ≥2 imaging examinations, including computerized tomography (CT), magnetic resonance (MR), and/or emission computed tomography (ECT). All patients were diagnosed by pathology after core needle or surgical biopsies. The results were compared with those of pathological examinations using paired chi-squared tests, and compared with each other. Statistical indicators that tested the consistency of the results included McNemar's and kappa coefficients, as well as receiver operating characteristic curves. RESULTS: The differences among MR, CT, ECT, and pathology were not significant. The kappa coefficient of MR, CT, and ECT was 46.1%, 36.0%, and 55.9%, respectively. The area under the curve of ECT, MR, and CT scans was 0.809, 0.705, and 0.704, respectively; and the differences among them were significant (P < .05). Post hoc multiple comparisons showed no significant differences among imaging examinations in terms of sensitivity, specificity, misdiagnosis rate, and coincidence rate (P > .05). However, significant differences were noted in the kappa coefficient and missed diagnosis rate (P < .05). CONCLUSIONS: Although ECT was the most accurate imaging method, its high cost and large radiation dosage limit its widespread application. Furthermore, MR verified spinal tumors more effectively; however, CT excluded them more efficiently. In summary, when all factors are considered, MR is still the optimal modality for the diagnosis of spinal tumors, especially during the initial screening.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imagem por Ressonância Magnética/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Diferenciação Celular , Cisplatino/farmacologia , Cisplatino/uso terapêutico , Epirubicina/farmacologia , Epirubicina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quinazolinas/farmacologia , Quinazolinas/uso terapêutico , Estudos Retrospectivos , Tiofenos/farmacologia , Tiofenos/uso terapêutico , Adulto Jovem
17.
Medicine (Baltimore) ; 99(25): e20430, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569166

RESUMO

To compare the efficacy and safety of kyphoplasty (KP) in the treatment of occult metastatic vertebral tumors (OMVT) and non-occult metastatic vertebral tumors (MVT).From January 2013 to December 2017, 65 cases of occult metastatic vertebral tumors and 82 cases of metastatic vertebral tumors were selected and divided into 2 groups. After KP, they were followed up by a year of outpatient visits and telephone calls. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores, the amount of bone cement injected, the change of vertebral height and the incidence of complications were recorded, compared and analyzed by SPSS software. t test was used to compare the differences between the same group of patients at different times and between the 2 groups of patients.In the OMVT group, the operation time was 24.52 ±â€Š4.24 minutes, the fluoroscopy time was 10.18 ±â€Š1.53 minutes and the volume of bone cement was 3.62 ±â€Š0.93 ml. The VAS score decreased from 7.26 ±â€Š01.08 preoperatively to 2.77 ±â€Š0.93 postoperatively (P < .01). The ODI score decreased from 64.89 ±â€Š9.05 preoperatively to 25.82 ±â€Š4.63 postoperatively (P < .01). In the MVT group, the operation time was 26.63 ±â€Š4.61 minutes, the fluoroscopy time was 11.04 ±â€Š2.15 minutes and the volume of bone cement was 4.09 ±â€Š1.10 ml. The VAS score decreased from 7.73 ±â€Š0.94 preoperatively to 3.22 ±â€Š0.80 postoperatively (P < .01). The ODI score decreased from 69.20 ±â€Š7.14 preoperatively to 28.02 ±â€Š4.40 postoperatively (P < .01). The vertebral height of MVT patients was significantly improved after operation (P < .01), but there was no difference in OMVT patients (P > .05).Occult metastatic vertebral tumors can be detected by Magnetic Resonance Imaging (MRI), and KP may be more effective and safer in the treatment of OMVT.


Assuntos
Doenças Assintomáticas/terapia , Cifoplastia/estatística & dados numéricos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/secundário
18.
Tech Vasc Interv Radiol ; 23(2): 100677, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591193

RESUMO

Percutaneous thermal ablation has proven to be safe and effective in the management of patients with spinal tumors. Such treatment is currently proposed following the decision of a multidisciplinary tumor board to patients with small painful benign tumors such as osteoid osteoma or osteoblastoma, as well as carefully selected patients presenting with spinal metastases. In both scenarios, in order to provide a clinically effective procedure, ablation is often tailored to the specific patients' clinical needs and features of the target tumor. In this review, we present the most common clinical contexts in which spine ablation may be proposed. We scrutinize technical aspects and challenges that may be encountered during the procedure, as well as offering insight on follow-up and expected outcomes.


Assuntos
Criocirurgia , Ablação por Radiofrequência , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/instrumentação , Fatores de Risco , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/instrumentação
19.
Turk Neurosurg ; 30(4): 588-594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530483

RESUMO

AIM: To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis. MATERIAL AND METHODS: Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients. RESULTS: One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18?90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others? presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days. CONCLUSION: Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.


Assuntos
Detecção Precoce de Câncer/métodos , Cifoplastia/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/cirurgia , Osteoporose/complicações , Osteoporose/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos , Adulto Jovem
20.
J Clin Neurosci ; 78: 128-134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32507710

RESUMO

Spinal solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal malignancy. Radiographically, SFT/HPCs have a mutable appearance, with irregular borders, heterogeneous contrast enhancement, and variable but frequently hypointense T2 signal. We report a series of 5 neurosurgically managed spinal SFT/HPCs treated at our institution, with particular attention to 3 lesions demonstrating marked T2-hypointensity and differential diagnosis for the unusual finding of a "T2 dark" spinal lesion. Retrospective chart review of prospectively maintained surgical database, queried by diagnosis and site codes, 2002-2017. Retrospective radiographic review, with initial screening via keyword search of MR reports for "T2" and "hypointense." Four primary and one metastatic spinal SFT/HPCs were operatively treated during the study period (median follow-up 12 months; range 10-92). Three demonstrated marked T2 hypointensity on preoperative MRI, underwent primary resection-GTR in two, STR in one-and have remained progression-free on routine postoperative surveillance. Two patients with isointense lesions recurred within the follow-up period. Radiographic review identified a host of predominantly rare T2-hypointense lesions, including arteriovenous malformation, disk fragmentations, calcific arachnoiditis, calcifying pseudoneoplasm of the neuraxis, cavernoma, cord hemorrhage/acute blood, desmoid, granulocytic sarcoma, pigmented villonodular synovitis, Edheim-Chester, extramedullary hematopoiesis, IgG4-negative inflammatory pseudotumor, idiopathic hypertrophic pachymeningitis, B-cell lymphoma, primary melanoma neoplasm, melanotic schwannoma, meningioma, opacification of the posterior longitudinal ligament, osteoblastoma, osteochondroma, osteosarcoma, and synovial cyst. T2 hypointensity is associated with SFT/HPC, and may be an indicator relative indolence. "Dark" T2 spinal lesions are rare, with a narrow differential populated predominantly by rare entities.


Assuntos
Hemangiopericitoma/diagnóstico por imagem , Hemangiopericitoma/cirurgia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA