Cases reported "Spinal Neoplasms"

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1/90. Synovial sarcoma in the parapharyngeal space: case report and review of the literature.

    We encountered a rare case of synovial sarcoma in the parapharynx of a 47-year-old Japanese man. This patient presented with an enlarging tumor in the right side of his neck that had grown progressively over a 4-week period. Radiological examinations revealed that the tumor arose from the parapharyngeal space. The tumor could not be completely removed at surgery. Metastasis to the lumbar vertebra was detected postoperatively. The patient underwent three courses of chemotherapy and the delivery of palliative radiation to the lumbar vertebra without success. The patient died of lung metastasis 7 months after surgery.
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2/90. Metastatic cardiac angiosarcoma of the cervical spine. Case report.

    STUDY DESIGN: A case report of metastatic cardiac angiosarcoma of the cervical spine. OBJECTIVES: To show that this rare spine tumor behaves in the same manner as an arteriovenous malformation and embolization, which can allow for successful spine surgery, and to discuss the natural history and rarity of this tumor. SUMMARY OF BACKGROUND DATA: Primary angiosarcoma of the heart is a very rare tumor, with fewer than 200 reports in the English literature and nothing reported in the spine literature. RESULTS: The patient in this study initially sought treatment for neck pain, left arm pain, and weakness 17 months after cardiac surgery and subsequent chemotherapy. A cervical computed tomography scan demonstrated a C5 lytic vertebral body tumor with intracannilicular extension and cord compression. An anterior cervical approach was made, but the tumor was too vascular to resect, and surgery was aborted. The C5 vascular vertebral body metastasis subsequently was embolized successfully by an interventional neuroradiologist. reoperation via an anterior approach with corpectomy, cadaveric fibula, and anterior locking plate internal fixation was successful, producing marked improvement in the patients' symptoms. CONCLUSION: Spinal involvement by primary cardiac angiosarcoma is very rare, and this is only the second operative case ever reported. The vascular nature of this tumor makes it behave in a manner similar to that of a high-flow arteriovenous malformation. Surgery should not be undertaken before preoperative angiography and embolization. The dismal prognosis for this rare malignancy is discussed.
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3/90. Cervical metastasis of occult papillary thyroid carcinoma associated with epidermoid carcinoma of the larynx.

    An occult, laterocervical papillary thyroid carcinoma tissue was found in a functional neck dissection for larynx cancer. The patient was a 76-year-old man with a history of smoking and alcohol ingestion who presented with a supraglottic carcinoma of the larynx located at the laryngeal surface of the epiglottis, left aryepiglottic fold, band and left ventricle with extension to the left vocal cord. light microscopy showed a lymph node with a fibrous stroma with lymphoid follicles that presented a total substitution of the parenchyma by a papillary thyroid carcinoma. Although examination of the thyroid gland by seriated sections did not reveal any neoplasm, we argue that the papillary thyroid tissue is metastatic.
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4/90. Osteoid osteoma of a cervical vertebral body.

    An osteoid osteoma in the anterior part of the body of the fourth cervical vertebra occurred in a 22-year-old female. The patient's main complaint was neck pain and occasional numbness of the extremities. The pain was relieved by analgesics. Plain radiography and a 99Tcm MDP bone scan showed a non-specific abnormality. CT suggested the pathological diagnosis with reasonable certainty. The unusual location of the lesion and the role of various diagnostic modalities are discussed and the literature reviewed.
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5/90. Malignant granular cell tumor metastatic to the orbit.

    OBJECTIVE: Malignant granular cell tumor is a rare type of soft tissue sarcoma. To our knowledge, ocular (eyelid) involvement has been described in only two cases. Herein, we report the clinicopathologic features of an unusual case of malignant granular cell tumor metastatic to the orbit. DESIGN: Observational case report. methods: Retrospective review of the medical record and the histopathologic and electron microscopic findings and review of the literature. RESULTS: A 72-year-old man with biopsy-proven granular cell tumor in the cervical region was initially seen with proptosis and motility disturbance. A magnetic resonance imaging scan showed a large intraconal mass, and biopsy of the orbital mass revealed granular cell tumor. Histopathologic examination of the primary neck tumor and the orbital mass revealed increased nuclear atypia and pleomorphism in the consecutive lesions. The morphologic impression of granular cell tumor was also supported by the immunohistochemical demonstration of S-100 protein expression and ultrastructural findings typical of granular cell tumor. Six months after the orbital involvement, systemic workup revealed multiple apparent bony and lung metastases. CONCLUSIONS: We report the first malignant granular cell tumor metastatic to the orbit and suggest the inclusion of this tumor in the differential diagnosis of metastatic orbital lesions.
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6/90. Malignant triton tumor in the thoracic spine.

    We present a 15-year-old patient diagnosed with peripheral neurofibromatosis (NF-1), who was admitted with paraparesis caused by a large intrathoracic tumor with an intracanalicular component that affected the spinal cord. After surgery his condition improved, but a year later he suffered a relapse and died. Histologically the tumor was diagnosed as malignant with neurogenic and myogenic differentiation ("malignant triton tumor"). Malignant triton tumors (MTT) are infrequent; those found in the head and neck and the upper or lower extremities have a better prognosis than those in the retroperitoneum, buttock, or trunk. It is not clear whether this variation is due to a difference in tumor grade, stage, or resectability, or whether it is a consequence of therapy.
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7/90. Cervical chordoma with vertebral artery encasement mimicking neurofibroma: MRI findings.

    A case of cervical chordoma in a 36-year-old white man with hypoesthesia in the neck and right shoulder, neck pain, and restricted neck mobility is presented. Plain radiographs of the cervical spine showed radiolucency of the body of C2 on the right side and enlargement of the right intervertebral foramen at C2-C3 level. Tumor encasement of the vertebral artery was demonstrated by MR imaging and confirmed by conventional arteriography. This proved to be particularly important for preoperative assessment.
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8/90. Metastatic testicular cancer presenting as spinal cord compression: report of two cases.

    BACKGROUND: Testicular cancers are heterogenous neoplasms often found in young adults. They tend to metastasize to the chest, retroperitoneum, or neck, but rarely to the long bones or skeleton. However, they can cause neurologic compromise and should be considered in young male patients who present with symptoms of a spine lesion and no known primary cancer. methods: Two patients presented with back pain and a rapid progression of lower extremity weakness. Both underwent radiographic workup and emergency surgery. Metastatic workup revealed testicular cancer and widespread metastases. RESULTS: Both patients improved neurologically after surgery, but neither regained the ability to ambulate independently. They both underwent chemotherapy. One patient is alive at 1 year follow-up; the other died 9 months after surgery of widespread metastases. CONCLUSIONS: Vertebral metastases from testicular tumors, although rare, should be considered in young men presenting with spinal cord compression. work-up should include magnetic resonance imaging (MRI) of the spine and computed tomography (CT) of the chest, abdomen, and pelvis. Urgent intervention may be required, as these two cases show that loss of neurologic function can be rapid and permanent.
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9/90. Intermittent vertebral artery compression caused by C1-root schwannoma: case report.

    Extradural schwannomas of the C1-root are extremely rare. As the tumor grows in size, it may compress surrounding neurovascular structures and cause symptoms. In the present case report, the left vertebral artery (VA) was severely compressed by the tumor, eliciting severe vertigo on turning the head to the right side and with neck extension. We report a 52-year-old man who presented with a history of intermittent episodes of severe vertigo on head movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion was yellowish in color and was extradural in location lying between the markedly eroded C1-posterior arch and the compressed vertebral artery (V3) on the left side. The medial portion of the tumor was attached to the C1-nerve root. The tumor was excised enbloc with decompression of the VA. The patient's symptoms completely resolved immediately following surgery, with no recurrence of the symptoms at one year follow up. The vertebral artery may frequently be compressed by osteophytes in cervical spondylosis or due to other causes in the cervical spinal canal, but compression of the artery by C1 extradural schwannoma with vascular insufficiency is rare. Removel of the tumor and the resultant decompression of the artery can be facilitated by the extreme lateral approach as demonstrated by this case.
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10/90. magnetic resonance imaging appearance of metastatic Merkel cell carcinoma to the sacrum and epidural space.

    Merkel cell carcinoma (MCC) is a rare malignant tumor of the skin and often is diagnosed histologically as lymphoma, melanoma and even metastatic small cell carcinoma of the lung (SCCL). Classified as a neuroendocrine tumor, clinically it originates in the head and neck region and may present with metastatic disease at the time of presentation [1]. Osseous involvement in the past has been described to involve regional facial bones only. We present the first reported MRI findings of distant osseous metastasis from a Merkel cell carcinoma to the lumbosacral spine with associated soft tissue and epidural involvement. Appropriate treatment and patient survival depend on prompt diagnostic imaging for establishment of metastatic disease. Previous reports have advocated CT for diagnosis and staging of distant metastases [2,3]. When spinal involvement is suspected, MRI may be a more suitable modality for assessment of the epidural space and appropriate staging and follow-up in such cases.
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