BACKGROUNDChordomas of the upper cervical spine are rare and present unique surgical challenge. This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.

METHODSTwenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed. Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.

RESULTSThe postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case. The mean operative time was 9.5 hours (range 6-17 hours), and the mean blood loss was 2 812 ml (range 700-4 800 ml). There were two postoperative deaths. Unilateral vertebral artery ligation was performed in six patients, cervical nerve roots were cut in six patients, and the external branch of the superior laryngeal nerve was repaired after being cut in one case. Two patients developed postoperative velopharyngeal incompetence, and loosening of the occipitocervical screws was observed in one patient. The recurrence rate was 66.7% (10/15) after a mean follow-up period of 46.8 months (range 14-150 months). The 5- and 10- year overall survival rates were (39.8±13.1)% and (31.9±12.7)%, respectively. There was a significant difference in survival rate between patients who underwent surgery and those who did not.

CONCLUSIONIn spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine, intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.

Adult ; Aged ; Cervical Vertebrae ; pathology ; surgery ; Chordoma ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; surgery ; Retrospective Studies ; Spinal Neoplasms ; pathology ; surgery ; Treatment Outcome

No abstract available.
Adolescent ; Back Pain/diagnosis/*etiology/surgery ; Decompression, Surgical ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Osteoblastoma/*complications/pathology/radiography/surgery ; Pain Measurement ; Radiotherapy, Adjuvant ; Spinal Neoplasms/*complications/pathology/radiography/surgery ; *Thoracic Vertebrae/pathology/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Adult ; Calmodulin-Binding Proteins ; metabolism ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Leiomyoma ; metabolism ; pathology ; surgery ; Leiomyosarcoma ; pathology ; Spinal Canal ; Spinal Neoplasms ; metabolism ; pathology ; surgery ; Young Adult

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

Antigens, Nuclear ; metabolism ; Cordotomy ; methods ; Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nerve Tissue Proteins ; metabolism ; Neurocytoma ; metabolism ; pathology ; surgery ; Oligodendroglioma ; S100 Proteins ; metabolism ; Spinal Cord Neoplasms ; metabolism ; pathology ; surgery ; Synaptophysin ; metabolism

Cervical Vertebrae ; Hemangioma, Cavernous ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Rupture, Spontaneous ; Spinal Canal ; pathology ; Spinal Neoplasms ; diagnosis ; surgery

Radiation-induced spinal cord gliomas are extremely rare. Since the first case was reported in 1980, only six additional cases have been reported.; The radiation-induced gliomas were related to the treatment of Hodgkin's lymphoma, thyroid cancer, and medullomyoblastoma, and to multiple chest fluoroscopic examinations in pulmonary tuberculosis patient. We report a case of radiation-induced spinal cord glioblastoma developed in a 17-year-old girl after a 13-year latency period following radiotherapy for nasopharyngeal rhabdomyosarcoma. MRI findings of our case are described.
Contrast Media/diagnostic use ; Female ; Gadolinium DTPA/diagnostic use ; Glioblastoma/*diagnosis/pathology/surgery ; Humans ; *Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms/*radiotherapy ; Neoplasms, Radiation-Induced/*diagnosis/pathology ; Rhabdomyosarcoma/*radiotherapy ; Spinal Cord Neoplasms/*diagnosis/pathology/surgery

Intradural schwannoma of the conus medullaris is a rare form of spinal neoplasm, which commonly occurs in the lumbar region. Conus medullaris level is unusual for schwannomas. A 49-year-old woman presented with chronic sciatica, mild bladder dysfunction, and paresthesia in the buttocks. Magnetic resonance imaging of the spine showed a mass lesion in the conus medullaris region with nerve compression. The tumor was completely resected and diagnosed histologically as schwannoma. The patient recovered after surgery. Clinical and radiologic features of this rare tumor are reviewed and are accompanied by literature findings.
Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma ; diagnosis ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism ; Spinal Cord Neoplasms ; diagnosis ; metabolism ; pathology ; surgery

OBJECTIVETo study the morphologic characteristics, immunophenotype and differential diagnosis of a case of microcystic/reticular schwannoma occurring in cervical spine.

METHODSThe pathologic features and immunophenotypic profile of a case of microcystic/reticular schwannoma were studied. Immunohistochemistry was performed using EnVision two-step method.

RESULTSThe patient was a 35-year-old male and presented with a bump over the fifth cervical spine on radiologic check up. Grossly, the bump was gray-white in color, soft, well-circumscribed but non-encapsulated. The tumor measured 3.5 cm × 3.0 cm × 1.8 cm in size. Histologically, it was composed of two distinctive components. One component resembled the conventional schwannoma but showed focally nuclear pleomorphism, reminiscent of changes in degenerating schwannoma. The other component consisted of epithelial-like cells arranged in a reticular or lace-like pattern, amongst a myxoid matrix. Immunohistochemical study showed that the tumor cells were strongly positive for vimentin, S-100 protein, glial fibrillary acidic protein and neuron-specific enolase, focally positive for CD68, CD10 and Ki-67, and negative for pan-cytokeratin, epithelial membrane antigen, neurofilament, carcinoembryonic antigen, smooth muscle actin, estrogen receptor, progesterone receptor and p53.

CONCLUSIONSMicrocystic/reticular schwannoma is a novel variant of schwannoma, arising mainly in internal viscera but seldom in bone. Awareness of this entity is helpful in distinction from chordoma, other mucoid tumors or sarcomas.

Adult ; Cervical Vertebrae ; Chondrosarcoma ; metabolism ; pathology ; Chordoma ; metabolism ; pathology ; Diagnosis, Differential ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Male ; Neurilemmoma ; metabolism ; pathology ; surgery ; Phosphopyruvate Hydratase ; metabolism ; S100 Proteins ; metabolism ; Sarcoma ; metabolism ; pathology ; Spinal Neoplasms ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

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