PRIMARY SPINE CHONDROSARCOMA: CASE REPORT AND LITERATURE REVIEW

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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

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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.

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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

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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

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DIAGNÓSTIC IMAGES
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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
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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.

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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

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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.

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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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MUCHAS GRACIAS