Carcinoma, Squamous Cell ; diagnosis ; Humans ; Maxilla ; pathology ; Maxillary Neoplasms ; diagnosis ; Neoplasm Metastasis ; Spinal Neoplasms ; secondary

Bone metastasis from a spinal cord astrocytoma has been reported only twice in the English medical literature. It is generally known that bone metastasis is found after the initial diagnosis with/without intervening surgery rather than being found at the time of the diagnosis of astrocytoma. The purpose of this article is to report for the first time a case of concurrent bone metastasis from a spinal cord astrocytoma at the time of diagnosing the spinal cord astrocytoma.
Astrocytoma/diagnosis/*secondary ; Humans ; *Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms/diagnosis/*pathology ; Spinal Neoplasms/diagnosis/*secondary ; *Thoracic Vertebrae

Hepatocellular carcinoma is one of the most common malignancies reported in Korean adult males. Hepatocellular carcinoma usually spreads to regional lymph nodes around porta hepatis via lymphatics and to distant metastasis via hematogenous spread. The lung is most common distant metastatic site, followed by the adrenal glands, local lymph nodes and bones. But metastasis to the spinal cord of hepatocellular carcinoma is very rare. Recently we experienced a patient with hepatocellular carcinoma who had suffered from lower leg weakness for 10 days. The patient was proved to have hepatocellular carcinoma with metastasis to the spinal cord. MRI showed an ovoid intracordal mass between the twelfth thoracic and first lumbar vertebra level. After emergency irradiation, the patient could recover.
Carcinoma, Hepatocellular/*secondary ; English Abstract ; Human ; Liver Neoplasms/*pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms/diagnosis/*secondary

The spine is the most common site of metastatic tumors. The highest incidence of metastatic tumors on the spine is in the lumbar region, followed by the thoracic and cervical levels. Most associated spinal cord lesions, however, are located in the thoracic spine. The goals of surgery is decompression of the neural tissues, prevention of neural injury by stabilization of the unstable spinal column,or pain control. When there is a need to decompress the neurologic tissues,the most direct approach is anterior because the most common site of metastatic tumors is in the vertebral body. Laminectomy alone is not effective in improving neurologic function. Nevertheless,the posterior approach is more accessible, less hazardous, and effective in the correction of deformity if combined with instrumentation. If complete vertebrectomy is feasible in anterior bone strut combined with anterior and posterior stabilization is necessary following the vertebrectomy.
Biopsy ; Humans ; Neoplasm Invasiveness ; Spinal Neoplasms ; diagnosis ; pathology ; secondary ; surgery ; Treatment Outcome

OBJECTIVETo study MRI changes of vertebral metastasis and their value in differential diagnosis.

METHODSMR films of 103 patients with vertebral metastasis confirmed clinically or pathologically were reviewed with all features recorded and analyzed.

RESULTS338 vertebrae were involved in 103 patients, including 82 in vertebral body only, 3 in appendix only and 253 in both. According to the shape of vertebral body and the characteristic abnormality, 335 vertebrae with body involved were divided into 4 types: Type I (97) with one single focus in the vertebral body, type II (102) with multiple foci with clear margin in the vertebral body, type III (16) with abnormal signal in the whole vertebral body and type IV (120) with abnormal signal in the whole or most part of vertebral body complicated with compression fracture. Among all these lesions, 114 showed concave superior and/or inferior edges and 116 protruding posterior and/or anterior borders. In 256 vertebrae with abnormal appendix, 238 showed abnormal pedicle of vertebral arch involving neighbouring part of vertebral body and 235 showed enlarged pedicle and other parts of the appendix. Soft tissue mass was showed around 133 vertebrae, with the center at the involved vertebrae on sagittal image. 130 pieces of these masses extended cranio-caudally within or a little beyond the width of a vertebral body.

CONCLUSIONVertebral metastasis is characterized by involving multiple vertebrae. Its diagnosis and differential diagnosis can be made definite in most patients according to the lesions distribution, change in vertebral shape and the characteristics of the soft tissue mass.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Neoplasms ; diagnosis ; secondary

BACKGROUNDThe usefulness of in-phase/opposed-phase imaging and diffusion weighted imaging (DWI) in differentiating benign and neoplastic vertebral fractures has been described. In this study, we aimed to evaluate the influence of the severity of vertebral damage on the diagnostic performance of these two technologies.

METHODSTotally 59 patients with 68 acute benign vertebral fractures and 43 patients with 79 vertebral metastases were included in this study. The MR protocol included DWIs and sagittal in-phase/opposed-phase gradient recalled sequence. The severity of vertebral damage was expressed by lesion ratio (LR, the ratio of lesion area to vertebral area on the slices of largest abnormal signal area in the T1-weighted sequence). Quantitative (signal intensity ratio (SIR) defined as signal intensity (SI) on opposed-phase gradient recalled echo (GRE) images divided by SI on in-phase; apparent diffusion coefficient (ADC) value derived from DWI analysis was performed, the relationships between LR and the measurements of these two technologies were analyzed using linear regression. The covariate-specific receiver operating characteristic (ROC) curves were also fitted to evaluate the influence of LR on the diagnostic performance of ADC and SIR.

RESULTSThe difference in both SIR and ADC for vertebral metastasis and acute benign vertebral fractures was significant (P < 0.001). A positive correlation between the LR and the SIR was found in benign fractures (P < 0.05). The severity of vertebral damage had a significant influence on the AUC (area under ROC curve) for SIR (P < 0.05) but ADC (P > 0.05). More severe cases were associated with increased AUC for SIR.

CONCLUSIONSLR is capable of affecting the diagnostic performances of chemical shift imaging. Thus, when applying these tests to make diagnoses on vertebral fractures, the severity of the vertebral damage should be taken into account. The covariate-specific ROC model is recommended because it substantially improves the ability to avoid bias when evaluating tests.

Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Spinal Neoplasms ; diagnosis ; secondary

Although intracranial dural metastasis of Ewing's sarcoma is a very rare finding, its imaging characteristics are similar to those of its primary form in the central nervous system. Thus, this tumor must be considered in the differential diagnosis of extra-axial dural masses.
Adult ; Dura Mater/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Sarcoma, Ewing's/diagnosis/*pathology/surgery ; Skull Neoplasms/diagnosis/*secondary/surgery ; Spinal Neoplasms/diagnosis/pathology/surgery ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the differences in selecting patients who will undergo operation by comparing the evaluating systems and to discuss the indication of surgery performed on patients with spinal metastases.

METHODSOf the 113 patients presented at Jishuitan Hospital, Beijing, PRC. from February 1994 to February 2002, who were diagnosed as spinal metastases, the clinical, pathological and imaging records of 82 patients were reviewed. Harrington's classification system, Tokuhashi's scoring system, Tomita's scoring system, and Grubb's scoring system were used to evaluate each of these patients at the same time. The classification or score concerning each patient was recorded and compared. SPSS software was used for statistical analysis. McNemar Test was used to compare the proportion of surgery indicated by different evaluating systems.

RESULTS(1) Surgical treatment was indicated for 92.7% of patients by Tomita's scoring system and 69.5% by Harrington's classification system respectively. The difference was statistically significant at the level of P < 0.001. (2) Seventy-five cases with spinal cord palsy and progressive pain could be assessed by Tokuhashi's system. These patients were evaluated by Tomita's system at the same time. The type of surgery determined by Tokuhashi's score was excisional operation for 20% of the patients, palliative operation for 20%. As for the remaining 60%, either excisional or palliative operation might be chosen. The type of surgery determined by Tomita's score was excisional operation for 49.3% of the patients, palliative for 42.7%, and nonsurgical modality for the remaining 8.0%. (3) Twenty-five patients were classified as I, II or III, by Harrington's classification system. These patients were evaluated by the Grubb scoring system to predict the possibility of pathologic fracture and by Tomita's system at the same time to determine if an operation was necessary. By Grubb's system, prophylactic stabilization was necessary for twenty-two patients. By Tomita's system, surgery was chosen for 23 patients. But the treatment options were different in 5 patients assessed by the two systems.

CONCLUSIONSThere was a great difference in the selection of treatment modality for patients with spinal metastases by different evaluating systems. That no systems have incorporated the evaluation of life expectancy and the local lesion causes differences. The patients should be evaluated individually by more factors than those proposed by the established systems.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Preoperative Care ; methods ; Prognosis ; Proportional Hazards Models ; Spinal Neoplasms ; diagnosis ; secondary ; Survival Analysis ; Young Adult

OBJECTIVETo evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor.

METHODSFrom January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients, 30 patients were male, and 12 patients were female, ranging in age from 28 to 76 years old, with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes, and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment, 6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits, and 5 patients had injuries of A degree, 3 patients had injuries of B degree, 4 patients had injuries of C degree, 6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression, tumor curettage and total vertebrectomy, which were decided based on Tomita classification. The pain, spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week, 3 months, 6 months, 1 year and 2 years after operation.

RESULTSOne patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise, 17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months, with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months, 6 months, 1 year and 2 years were 95.2%, 85.7%, 58.2%, 37.6% respectively.

CONCLUSIONAccording to Tomita system, the different surgical treatments can be selected for patients with spinal metastatic tumors, which can relieve pain, improve the neurological status and spine stabilization, maintain local control, improve quality of life.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Neoplasms ; diagnosis ; secondary ; surgery ; Thoracic Vertebrae ; Treatment Outcome

Dysembryoplastic neuroepithelial tumors (DNETs) arise mostly in the supratentorial cerebral cortex. A very rare case of intraventricular DNET with diffuse ependymal involvement, which causes spinal drop metastasis, is presented.
Adult ; Diagnosis, Differential ; Ependymoma/*pathology/radiotherapy ; Female ; Humans ; Lumbosacral Region/*pathology ; *Magnetic Resonance Imaging ; Neuroepithelial Cells/pathology ; Spinal Neoplasms/radiotherapy/*secondary