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1.
AJR Am J Roentgenol ; 216(3): 734-741, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33405947

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the added value of proton density fat fraction (PDFF) in differentiating vertebral metastases from focal hematopoietic marrow depositions. MATERIALS AND METHODS. The study included 44 patients with 30 vertebral metastases and 14 focal hematopoietic marrow depositions who underwent spinal MRI. The final diagnoses were based on histologic confirmation, follow-up MRI, or PET/CT. Two musculoskeletal radiologists with 1 and 15 years of experience independently interpreted both image sets (i.e., images from conventional MRI alone versus images from conventional MRI and PDFF combined). Using a 5-point scale, the readers scored their confidence in the malignancy of the vertebral lesions. The diagnostic performance (AUC) of the two image sets was assessed via ROC curve analyses. Sensitivities, specificities, and accuracies (for both image sets) were compared using the McNemar test. Kappa coefficients were calculated to assess interobserver agreement. RESULTS. Both readers showed improved diagnostic performance after PDFF was added (AUC, 0.840-0.912 and 0.805-0.895 for readers 1 and 2, respectively). However, adding PDFF did not significantly improve the sensitivity and specificity of either reader (p > .05). Interobserver agreement significantly improved from moderate (κ = 0.563) to excellent (κ = 0.947) after PDFF was added. CONCLUSION. The addition of PDFF to a conventional MRI protocol improved the diagnostic performance for differentiating vertebral metastases from focal hematopoietic marrow depositions but without resulting in significant improvement in sensitivity and specificity.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Hematopoese , Imagem por Ressonância Magnética/métodos , Prótons , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Medula Óssea/patologia , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Coluna Vertebral/secundário
2.
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
3.
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
4.
Muscle Nerve ; 63(3): E21-E24, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33314145

Assuntos
/efeitos adversos , Melanoma/tratamento farmacológico , Doenças Musculares/induzido quimicamente , Miosite/induzido quimicamente , Miotonia Congênita/complicações , Distrofia Miotônica/complicações , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Cardiomiopatia Dilatada , Canais de Cloreto/genética , Conectina/genética , Transtornos de Deglutição/induzido quimicamente , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Eletrodiagnóstico , Eletromiografia , Humanos , Ipilimumab/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Melanoma/secundário , Doenças Musculares/complicações , Doenças Musculares/genética , Doenças Musculares/fisiopatologia , Miosite/complicações , Miosite/diagnóstico , Miosite/fisiopatologia , Miotonia Congênita/diagnóstico , Miotonia Congênita/genética , Miotonia Congênita/fisiopatologia , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/fisiopatologia , Condução Nervosa , Nivolumabe/efeitos adversos , Parestesia/induzido quimicamente , Parestesia/complicações , Parestesia/fisiopatologia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Proteínas de Ligação a RNA/genética , Neoplasias Cutâneas/patologia , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário
5.
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
6.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334759

RESUMO

A 67-year-old man presented to his general practitioner with intermittent episodes of unilateral sciatica over a 2-month period for which he was referred for an outpatient MRI of his spine. This evidenced a significant lumbar vertebral mass that showed tight canal stenosis and compression of the cauda equina. The patient was sent to the emergency department for management by orthopaedic surgeons. He was mobilising independently, pain free on arrival and without neurological deficit on assessment. Clinically, this patient presented with no red flag symptoms of cauda equina syndrome or reason to suspect malignancy. In these circumstances, National Institute for Health and Care Excellence guidelines do not support radiological investigation of the spine outside of specialist services. However, in this case, investigation helped deliver urgent care for cancer that otherwise may have been delayed. This leads to the question, do the current guidelines meet clinical requirements?


Assuntos
Adenocarcinoma/diagnóstico , Síndrome da Cauda Equina/diagnóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Estenose Espinal/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Idoso , Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/sangue , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/terapia , Quimiorradioterapia/métodos , Humanos , Biópsia Guiada por Imagem , Calicreínas/sangue , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Cuidados Paliativos/métodos , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Neoplasias da Coluna Vertebral/sangue , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/secundário , Estenose Espinal/etiologia , Estenose Espinal/terapia , Ultrassonografia de Intervenção
7.
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
8.
Anticancer Res ; 40(10): 5673-5678, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988892

RESUMO

BACKGROUND/AIM: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. RESULTS: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. CONCLUSION: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Compressão da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Reoperação/métodos , Compressão da Medula Espinal/sangue , Compressão da Medula Espinal/fisiopatologia , Disrafismo Espinal/sangue , Disrafismo Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/sangue , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
9.
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
10.
J Clin Neurosci ; 78: 73-78, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600973

RESUMO

Breast cancer spinal metastases (BCSM) are common and require proper treatment that leads to an improvement of the quality of life and contributes to the quod vitam prognosis. Surgical treatment is often required for intractable pain, spinal cord compression or spinal instability. The aim of this retrospective study is to identify which prognostic factors could affect postoperative overall survival in patients affected by BCSM. We report a retrospective cohort study of patients with BCSM, surgically treated from September 2009 to May 2018. Demographic and clinical data were collected. Kaplan-Meier method was used to estimate overall survival, and the log-rank test was used to compare survival curves. A total of 77 patients were studied. The median age at the time of surgery was 54 years. The median follow-up was 49 months. The 3-year and 5-year overall survival rates were 61% (95%CI: 47.5-72.1) and 43.3% (95%CI: 28.8-57.1). Metastatic bone disease (p = 0.0196), preoperative neurological impairment (p = 0.0029), Karnofsky status <70 (p = 0.0241) reduce survival. With multivariate analysis, the effect of Karnofsky score loses statistical significance. The presence of concurrent bone metastases and a preoperative neurological deficit are independent prognostic factors. Therapeutic choices are based on a multidisciplinary assessment that takes into consideration several factors, including an accurate study of prognostic factors.


Assuntos
Neoplasias da Mama , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Dor Intratável/cirurgia , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Coluna Vertebral/cirurgia , Taxa de Sobrevida
11.
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
13.
Medicine (Baltimore) ; 99(22): e20397, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481429

RESUMO

RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS: A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS: Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS: Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES: A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS: Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.


Assuntos
Hiperostose Esquelética Difusa Idiopática/complicações , Neoplasias da Coluna Vertebral/secundário , Idoso , Blefaroptose , Neoplasias da Mama/patologia , Anormalidades Congênitas , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Hiperostose Esquelética Difusa Idiopática/cirurgia , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
14.
World Neurosurg ; 140: 301-302, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32474088

RESUMO

Diffuse intrinsic pontine glioma with H3 K27M mutation is a rare brain tumor that primarily affects children. It is extremely lethal, and our understanding of the natural course of this disease, and how it progresses, is lacking. We have presented a case that demonstrates how aggressive this disease can be after progression, with remarkable spread throughout the brain and spine despite upfront radiotherapy. Although rarely reported, widespread dissemination of metastatic diffuse intrinsic pontine glioma throughout the brain and spine is possible.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias do Tronco Encefálico/patologia , Glioma Pontino Intrínseco Difuso/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Criança , Glioma Pontino Intrínseco Difuso/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias da Coluna Vertebral/diagnóstico por imagem
15.
World Neurosurg ; 140: 320-324, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32428722

RESUMO

BACKGROUND: Metastatic malignant melanoma of the spine is rare, while the spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is even rarer. Summarizing and analyzing this disease can provide insight into disease development and allow optimization of clinical management. CASE DESCRIPTION: A 55-year-old male patient was admitted to our institution presenting with lower back pain that had persisted for 3 years. It was aggravated, with radiating pain in bilateral lower extremities lasting 2 weeks. Neurologic examination revealed bilateral L5 motor deficit with paresis. Radiologic findings showed an irregularly destructive lesion of the L5 vertebral body, and the lesion extended dorsally, obstructing the spinal canal. The patient underwent complete resection of the L5 vertebral tumor with titanium mesh implantation and posterior fusion and instrumentation from L3-S2. The pathologic diagnosis after surgery was malignant melanoma. No obvious primary lesion was detected anywhere on the skin surface, mucosa, and retina. A postoperative positron emission tomography-computed tomography scan of the whole body displayed no abnormal uptake in other parts of the body. However, the patient didn't receive any chemotherapy or radiotherapy. Five months after operation, the tumor recurred and metastasis was detected in other sites. CONCLUSIONS: Although spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is rare, effective management and treatment of these patients remains an important challenge for surgeons. Surgical resection can alleviate patients' chief complaints and improve their quality of life. However, it may not prolong the survival period and improve the prognosis. Postoperative radiotherapy and/or chemotherapy may be needed.


Assuntos
Melanoma/complicações , Radiculopatia/etiologia , Neoplasias da Coluna Vertebral/complicações , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
16.
BMC Neurol ; 20(1): 178, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393192

RESUMO

BACKGROUND: Glioblastoma multiforme (GBM) is one of the most aggressive malignant brain tumors. Intracranial GBM metastases to the spine are rarely detected clinically. Secondary gliosarcomas after treatment of primary GBM are rarely described. CASE PRESENTATION: Herein, we report the case of a 53-year-old woman who presented to our emergency room with progressive headache and weakness on the left side. Plain computed tomography and contrast magnetic resonance imaging of the brain revealed an approximately 6.8 cm × 4.5 cm right temporoparietooccipital intraaxial cystic tumor with surrounding diffuse perifocal edema that caused midline shift toward the left. Emergency craniotomy was performed to remove the tumor, and pathological examination revealed GBM. The patient received proton beam therapy, Gliadel implantation, and oral temozolomide chemotherapy as well as targeted therapy with bevacizumab. Approximately 15 months after diagnosis, she underwent surgical resection of the right temporal recurrent tumor and was newly diagnosed as having a metastatic spinal tumor. Pathologically, the right temporal and metastatic spinal tumors were gliosarcoma and GBM, respectively. CONCLUSIONS: Concurrent spinal metastasis and gliosarcomatous transformation, which are two types of GBM complications, are rare. To our knowledge, this is the first report of a case of recurrent GBM with gliosarcoma after proton bean therapy.


Assuntos
Neoplasias Encefálicas/patologia , Encéfalo/patologia , Glioblastoma/secundário , Gliossarcoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Coluna Vertebral/secundário , Antineoplásicos Alquilantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Craniotomia , Evolução Fatal , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/terapia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Terapia com Prótons , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Temozolomida/uso terapêutico , Tomografia Computadorizada por Raios X
17.
Med Oncol ; 37(6): 53, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32361890

RESUMO

Bone metastasis in the spine are lesions that are very challenging to manage because of pain, possible respiratory and neurological complications due to the closeness with the spinal cord. In fact, a fracture of a vertebra weakened by a pathological tissue can occur. In this paper, an experience of a single center in treating bone metastasis in the vertebral soma is reported (both fractured than with an increased risk of fracture) with a combined procedure of ablation, vertebroplasty and radiotherapy. This combined strategy aims to obtain an increased ability to treat the pathological tissue (ablation and radiotherapy) and a stabilization of the osteolytic lesion (vertebroplasty). We evaluated the outcome of this procedure in 12 lesions (in 11 patients) with a follow-up (from 6 to 48 months) with clinical and imaging data. Patients showed an immediate, rapid and persistent regression of the symptomatology in all lesions except two. Moreover, a stability of the disease in the bone segment treatment was reached. Even if this is a pilot study for the number of patients and the follow-up, we believe that this approach could be promising as these early results are. In specific clinical conditions and selected patients, this study seems to be possible to perform a curative approach.


Assuntos
Ablação por Cateter/métodos , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/terapia , Vertebroplastia/métodos , Idoso , Terapia Combinada , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Qualidade de Vida , Radioterapia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/cirurgia
18.
Br J Radiol ; 93(1112): 20190891, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32462885

RESUMO

OBJECTIVE: To explore the value of related parameters in monoexponential, biexponential, and stretched-exponential models of diffusion-weighted imaging (DWI) in differentiating metastases and myeloma in the spine. METHODS: 53 metastases and 16 myeloma patients underwent MRI with 10 b-values (0-1500 s/mm2). Parameters of apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), the distribution diffusion coefficient (DDC), and intravoxel water diffusion heterogeneity (α) from DWI were calculated. The independent sample t test and the Mann-Whiney U test were used to compare the statistical difference of the parameter values between the two. Receiver operating characteristics (ROC) curve analysis was used to identify the diagnostic efficacy. Then substituted each parameter into the decision tree model and logistic regression model, identified meaningful parameters, and evaluated their joint diagnostic performance. RESULTS: The ADC, D, and α values of metastases were higher than those of myeloma, whereas the D* value was lower than that of myeloma, and the difference was significant (p < 0.05); the area under the ROC curve for the above parameters was 0.661, 0.710, 0.781, and 0.743, respectively. There was no significant difference in the f and DDC values (p > 0.05). D and α were found to conform to the decision tree model, and the accuracy of model diagnosis was 84.1%. ADC and α were found to conform to the logistic regression model, and the accuracy was 87.0%. CONCLUSION: The 3 models of DWI have certain values indifferentiating metastases and myeloma in spine, and the diagnostic performance of ADC, D, α and D*was better. Combining ADC with α may markedly aid in the differential diagnosis of the two. ADVANCES IN KNOWLEDGE: Monoexponential, biexponential, and stretched-exponential models can offer additional information in the differential diagnosis of metastases and myeloma in the spine. Decision tree model and logistic regression model are effective methods to help further distinguish the two.


Assuntos
Imagem de Difusão por Ressonância Magnética , Mieloma Múltiplo/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/patologia , Análise Multivariada , Curva ROC , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/diagnóstico por imagem
19.
Medicine (Baltimore) ; 99(16): e19838, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312006

RESUMO

Renal cell carcinoma (RCC) has been traditionally thought to be radioresistant. This retrospective cohort study aims to assess the outcomes of patients with spinal metastases from RCC treated with conventionally-fractionated external beam radiation therapy (cEBRT) in our institution.Patients diagnosed with histologically or radiologically-proven RCC who received palliative cEBRT to spinal metastases, using 3-dimensional conformal technique between 2009 and 2018 were reviewed. Local progression-free survival (PFS), overall survival (OS) and common terminology criteria for adverse events version 4.0-graded toxicity were assessed. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate for predictors associated with survivals.Thirty-five eligible patients with forty spinal segments were identified, with a median follow-up of 7 months (range, 0-47). The median equivalent dose in 2 Gy fractions (EQD2) was 32.5 Gy 10 (range, 12-39). Thirty-seven percent of patients underwent surgical intervention. At the time of last follow-up, all but 1 patient had died. Seven patients developed local progression, with the median time to local progression of 10.2 months. The median local PFS and OS were 3.3 and 4.8 months. There was no grade 3 or higher toxicity. A higher radiation dose (equivalent dose to 2 Gy fraction <32.5 Gy 10 vs ≥32.5Gy 10) (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.17-3.18; P-value (P) = .68) and spinal surgery (HR, 2.35; 95% CI, 0.53-10.29; P = .26) were not significantly associated with local PFS on univariable analysis. Multivariable analysis showed that higher Tokuhashi score (HR, 0.41; 95% CI, 0.19-0.88; P = .02), lower number of spinal segments irradiated (HR, 1.18; 95% CI, 1.01-1.37; P = .04) and use of targeted therapy (HR, 0.41; 95% CI, 0.18-0.96; P = .04) were independent predictors for improved OS.For an unselected group of patients with RCC, there is no significant association between higher radiation dose and improved local control following cEBRT. This may be due to their short survivals. With the use of more effective systemic therapy, including targeted therapy and immunotherapy, survival will likely be prolonged. A tailored-approach is needed to identify patients with good prognosis who may still benefit from aggressive local treatments.


Assuntos
Carcinoma de Células Renais/complicações , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imunoterapia/métodos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Intervalo Livre de Progressão , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Coluna Vertebral/efeitos da radiação , Resultado do Tratamento
20.
World Neurosurg ; 139: e601-e607, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330623

RESUMO

OBJECTIVE: Tumors of the cervical spine often encase 1 or both vertebral arteries (VA), presenting the treating surgeon with the dilemma of whether to sacrifice or skeletonize the artery. We propose an algorithm for VA management in surgeries for cervical neoplasms METHODS: A retrospective review was carried out of 67 patients undergoing resection of cervical spine tumors with VA involvement. Patients were categorized by tumor origin (primary vs. metastatic) and degree of circumferential VA involvement: 1) abutment only; 2) <180° circumferential involvement; 3) >180° circumferential involvement without complete encasement; or 4) complete encasement. RESULTS: Twelve patients (18%) underwent VA sacrifice, whereas 55 (82%) underwent VA skeletonization. Compared with 11/30 patients with primary tumors (37%), only 1/37 patients (3%) with metastatic disease underwent VA sacrifice (P < 0.01). This patient had invasion of the V2 arterial wall, requiring VA sacrifice. Odds of VA sacrifice also increased with increasing circumferential involvement (P < 0.01). No patients with simple abutment or 0°-180° circumferential involvement underwent sacrifice, whereas 6 of 10 (60%) with 180°-359° involvement and 6 of 29 (21%) with complete encasement underwent VA sacrifice. Of the 27 patients with ≥180° involvement, the reasons for preserving the VA were metastatic disease at the time of treatment (n = 18), a compromised contralateral VA (n = 7), vertebrobasilar junction aplasia (n = 1), and presence of a radiculomedullary artery at the affected level (n = 1). CONCLUSIONS: Primary tumor disease and >180° of circumferential VA involvement should be considered as indications for intraoperative sacrifice of the VA pending preoperative angiographic evaluation for contraindications.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Artéria Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento , Adulto Jovem
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