Transcript PRIMARY SPINE CHONDROSARCOMA: CASE REPORT AND LITERATURE REVIEW CARLOS FERNANDO LOZANO TANGUA MD LUIS RAFAEL MOSCOTE SALAZAR MD FREDY ANTONIO LLAMAS CANO MD RUBEN SABOGAL BARRIOS MD OSVALDO.

PRIMARY SPINE
CHONDROSARCOMA:
CASE REPORT AND
LITERATURE REVIEW
CARLOS FERNANDO LOZANO TANGUA MD
LUIS RAFAEL MOSCOTE SALAZAR MD
FREDY ANTONIO LLAMAS CANO MD
RUBEN SABOGAL BARRIOS MD
OSVALDO MOLINA OLIER MD
GABRIEL ALCALA-CERRA
UNIVERSIDAD DE CARTAGENA
2009
ABSTRACT

CHONDROSARCOMA IS THE THIRD MOST COMMON
PRIMARY NEOPLASM OF BONE AFTER MYELOMA AND
OSTEOSARCOMA, AND AFFECTING PRIMARILY QUE
PELVIC
AND
SHOULDER
GIRDLES.
THE
CHONDROSARCOMA ES EXTREMELY RARE IN THE
SPINE, IS COMPOSED OF HYALINE CARTILAGE MATRIX
AND CHONDROCYTES. WE PRESENTED A CASE OF A 65
YEARS OLD MAN WHITH A RARE CHONDROSARCOMA
GRADE III OF THE HIGH LUMBAR SPINE AND A REVIEW
OF THE LITERATURE.
CASE REPORT
A 65 YEARS OLD MAN, FARMERAND RIGHT HAND DOMINANCE.
HE CONSULTING FOR A CLINICAL PICTURE OF 7 MONTHS OF
SYMPOMS, DECREASE OF THE MUSCULAR FORCE THAT
AFFECTS THE MARCH AND SEVERE PAIN IN THE WHOLE
LUMBAR SEGMENT IRRADIATE TO LEGS. THE PAIN
INCREASES WITH VALSALVA's MANEUVERS AND DIMINISHES
WITH THE DECUBITUS.
FOR 15 DAYS HE PRESENTS VESICAL AND ANAL INCONTINENCE
IN MANAGING WITH DISPOSABLE DIAPER. IN THE LAST WEEK
HE HAS PRESENTED EDEMA OF THE LOW EXTREMITIES. HE
DENIES LOST OF I WEIGH OR FEVER
CASE REPORT
THE PHYSICAL EXAMINATION REVEALS SYNDROME OF
COMPRESSION OF MEDULAR CONUS MINCINGLY OF
NERVOUS ROOTS FROM L2 (MIXED DISORDER). THE
HEMOGRAMA REVEALS ANEMIA WITH LIGHT INCREASE OF
LACTIC DESHIDROGENASA. NORMAL TESTS OF HEPATIC AND
RENAL FUNCTION. TUMOUR COMMON SCOREBOARDS ARE
NEGATIVE. THE PATIENT WAS HOSPITALIZED FOR STUDIES
FOR IMAGE FOR SUSPICION OF PRIMARY TUMOR VERSUS
VERTEBRAL METASTASIS
THE X-RAY REVEALS BONY INFILTRATING LESION OF L1 MIXED,
OF PREDOMINANCE LYTIC AND INFILTRATIVE TUMOR
LESSION THAT AFFECTS ANTERIOR AND POSTERIOR ARCHES
THE OSSEUS GAMAGRAPHIE REVEALS IMPREGNATION OF
CONTRAST TO HIGH LUMBAR VERTEBRAE (L1) WITHOUT
OTHER AREAS OF HYPERCAPTATION
DIAGNÓSTIC IMAGES
THE SIMPLE MRI
REVEAL
LESION
THAT
COMPROMISES
SOFT TISSUES AND
VERTEBRAL BONE.
WITH INVATION OF
RACHIDEAL SPACE
AND
CONUS
COMPRESSION
ALSO
IMPORTANT
COMMITMENT
OF
PARAESPINAL
MUSCLES
IS
OBSERVED
CASE REPORT
IN NEUROSURGERY DESICION MEETING, IT IS DECIDED TO
REALIZE DECOMPRESSION AND BIOPSY IN ORDEN TO
OBTAIN A PATHOLOGIC TUMOR CLASSIFICATION. THE
HISTOPATOLOGYC STUDY REVEAL MALIGNANT TUMOUR OF
MESENCHIMAL LINAGE CONSTITUTED BY PROLIFERATION OF
FUSIFORM
AND
BINUCLEATED
CELLS
ARRANGE
DISORGANIZED FORM OVER A CONDROID MATRIX WITH
AREAS OF NECROSIS AND HEMORRHAGE.
IN NEW INTERDISCIPLINARY DESICION MEETING IT CASE IS
CHECKED. THE PROPOSED TRATMENT IS THE EXCISION IN
BLOCK OF THE SEGMENT OF THE AFFECTED COLUMN PLUS
INSTRUMENTAL FIXATION. THE PATIENT REJECTS THE OFFER
AND FOR THIS MOTIVE CONVENTIONAL RADIOTHERAPY
BEGINS. NOWADAYS THE PATIENT RECOVERED THE MARCH
AND THE CONTROL OF THE ANAL SPHINCTER. EVEN SHE HAS
MANAGING WITH VESICAL PROBE. HE(SHE) IS PRESENT AT
CONTROLS WITH NEUROSURGERY EVERY 3 MONTHS.
LITERATURE REVIEW
TUMORS OF SPINE NEAR 90% ARE METASTASIS AND 10% PRIMARY
TUMORS
CHONDROSARCOMA IS THE 4-8% OF PRIMARY SPINAL TUMORS.
THE MAXIMAL INCIDENCE IS FOUND IN PATIENTS FROM 30-70 YEARS
OF AGE. RARELY THE CHONDROSARCOMA OCCUR BEFORE THE 20
YEARS OLD. IS MORE FREQUENT ON MALE POPULATION.
THE SEGMENT OF COLUMN MORE FREQUENTLY AFFECTED IS NEAR TO
70% THE TORACO-LUMBAR SPINE
IS INFREQUENT THE TUMOR PRESENTATION BEFORE THE 20 YEARS.
HISTOLOGIC GRADING VARIATES, RANGES FROM 1 TO 3. THE GRADE 4
CORRESPONDING TO INDUFFERENTIATED TUMOR
RADIOGRAPHICALLY, THE CHONDROSARCOMA IS ASSOCIATED WITH A
LARGE AREA OF BONE DESTRUCTION AND A SOFT TISSUES MASS
HAVING CALCIFICATIONS. THE LESION MAY BE PRIMARILY LYTIC
LITERATURE REVIEW
FREQUENTLY THE POSTERIOR ARCH AND RIB-VERTEBRAL
ARTICULATION IS INVOLVED, CAUSING A PALPABLE MASS.
BECAUSE CHONDROSARCOMA GROWS SLOWLY, LOCAL
RECURRENCE AND METASTASES MAY OCCUR MORE THAN 10
YEARS AFTER TUMOR SURGERY REMOTION.
THE CHONDROSARCOMA IS GENERALLY RESISTANT TO MOST
PROTOCOLS OF RADIATION THERAPY AND CHEMOTHERAPY.
THE THERAPEUTIC GOAL IN UNIQUE LESION IS IN BLOCK
RESECTION AND COMPLEMENTARY RADIOTHERAPY
THE PROGNOSIS IS ACCORDING TO THE DEGREE
CLASIFICATION.
CONCLUSION
THE CHONDROSARCOMA IS A EXTREMELY INFREQUENT TUMOR
LESION. ONLY 0,5-1% OF ALL SPINE TUMORS (4-8% OF
PRIMARY TUMORS)
IN DEVELOPING COUNTRIES, THE PATIENTS CONSULTING
LATEST AND THE PATHOLOGY IS FRECUENTLY ADVANCED IN
STAGE.
THE GOAL OF TREATMENT IN LOCALIZED TUMORS IS IN BLOCK
RESECTION PLUS RADIOTHERAPY COMPLEMENTARY.
NOT ALL OF PATIENTS CONTINUES THE MEDICAL
RECOMENDATIONS ABOUT THE THERAPEUTIC GROUP.
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