Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.
Bone Cysts ; Bone Diseases, Metabolic ; Bone Resorption ; Decompression ; Diagnosis ; Diagnosis, Differential ; Giant Cell Tumors ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hyperparathyroidism, Secondary ; Hyperplasia ; Kidney Calculi ; Kidney Failure, Chronic ; Lymphoma ; Paraparesis ; Parathyroid Neoplasms ; Plasmacytoma ; Radiculopathy ; Spinal Cord Diseases ; Spine*

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

Intramedullary spinal cord metastasis (ISCM) from renal cell carcinoma (RCC) is rare manifestation and most of them are treated by adjuvant treatment modalities like radiotherapy. Despite the radio-resistance of RCC itself, focal radiotherapy has been preferred as the first-line treatment modality of ISCM from RCC and only a few cases underwent surgical treatment. We describe a case of ISCM from RCC, which underwent surgical excision and pathologically confirmed. A 44-yr-old man was presented with rapid deterioration of motor weakness during focal radiotherapy for ISCM from RCC. After the surgery for removal of the tumor mass and spinal cord decompression, his motor power was dramatically improved to ambulate by himself. We report the first published Korean case of ISCM from RCC confirmed pathologically and describe our surgical experience and his clinical characteristics.
Adult ; Carcinoma, Renal Cell/*diagnosis/pathology/surgery ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Magnetic Resonance Imaging ; Male ; Motor Activity/physiology ; Spinal Cord Neoplasms/pathology/secondary/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Vimentin/metabolism

OBJECTIVETo identify the survival prognostic factors and clinical outcome of the patients with spinal metastatic tumors and to discuss the surgical treatment strategy of spinal metastatic tumors.

METHODSThe patients with spinal metastatic tumors who received surgeries during January 2003 to June 2012 were enrolled. The survival was analyzed by Kaplan-Meier survival curve. The prognostic factors, divided into patient-related factors, tumor-related factors and therapy-related factors, were analyzed univariately and multivariately by Cox comparative hazard model.

RESULTSThere were 453 patients were enrolled in research including 263 male and 190 female patients with an average age of (56 ± 13) years (10-86 years). The median postoperative survival was 9 months. Local recurrences and peri-operative complications were found in 78 (17.2%) and 72 (15.9%) patients, respectively. Univariate analysis showed the significant prognostic factors for postoperative survival included poor preoperative general condition (χ(2) = 4.16), severe preoperative neurologic deficit(χ(2) = 10.23), not receiving bisphosphonate therapy(χ(2) = 10.47), short disease-free interval before spinal metastasis (χ(2) = 23.31), spinal metastasis as the first manifestation (χ(2) = 10.94), rapid-growth primary tumor(χ(2) = 15.45), visceral metastasis (χ(2) = 4.10), not receiving postoperative radiotherapy(χ(2) = 18.10) and not receiving post-operative sensitive systemic therapy(χ(2) = 11.20) (P < 0.05). Multivariate analysis showed the independent prognostic factors include severe preoperative neurologic deficit (P = 0.012, 95%CI: 1.11-2.30), short disease-free interval before spinal metastasis (P = 0.023, 95%CI:1.05-1.83), rapid-growth primary tumor (P = 0.000, 95%CI:1.74-3.06), visceral metastasis (P = 0.008, 95%CI: 1.08-1.68), not receiving postoperative radiotherapy (P = 0.000, 95%CI:1.38-2.35) and not receiving post-operative sensitive systemic therapy (P = 0.045, 95%CI:1.01-1.58).

CONCLUSIONThe prognostic factors for survival are useful for determining the indication of operation and improving survival and clinical outcome for patients with spinal metastatic tumors.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Spinal Neoplasms ; diagnosis ; secondary ; surgery ; Treatment Outcome ; Young Adult

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

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

Transcatheter arterial chemoembolization (TACE) has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.
Antiviral Agents/therapeutic use ; Bone Neoplasms/radiography/secondary ; Carcinoma, Hepatocellular/diagnosis/pathology/*therapy ; Catheter Ablation ; Chemoembolization, Therapeutic/*adverse effects ; Hepatitis B/complications/drug therapy ; Humans ; Liver Cirrhosis/etiology ; Liver Neoplasms/diagnosis/pathology/*therapy ; Male ; Middle Aged ; Positron-Emission Tomography ; Soft Tissue Neoplasms/secondary ; Spinal Cord Injuries/*etiology ; Tomography, X-Ray Computed

Nasopharyngeal cancer (NPC) is a common malignancy affecting Asian countries, especially the Chinese population. Treatment regimes and results have improved over the years with better overall survival outcome data. Radiotherapy with or without chemotherapy is successful in many patients. Local recurrences are treated with nasopharyngectomy or another course of radiotherapy. The upper cervical spine and skull base can also be involved in NPC patients. Possible aetiologies are osteoradionecrosis, chronic infection and tumour invasion. This article reviews the NPC involvement of C1-2 due to the various pathologies as well as the diagnostic and surgical treatment strategies. Three clinical cases that were surgically treated are discussed along with a review of the current literature.
Adult ; Aged ; Bone Neoplasms ; secondary ; Carcinoma ; Cervical Vertebrae ; drug effects ; radiation effects ; China ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; surgery ; Osteomyelitis ; diagnosis ; etiology ; surgery ; Osteoradionecrosis ; etiology ; Recurrence ; Spinal Fractures ; etiology ; Treatment Outcome

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

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