Gastrointestinal stromal tumor with multisegmental spinal metastases as first presentation:A case report and review of the literature

BACKGROUND Gastrointestinal stromal tumor(GIST)usually originates in the stomach,followed by the small intestine,rectum,and other parts of the gastrointestinal tract.The most common sites of metastasis are the liver and peritoneum,whereas spinal metastases from GIST are extremely rare.CASE SUMMARY We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae.A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause.Subsequently,computed tomography(CT)and magnetic resonance imaging(MRI)revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis,which was considered as tumor metastasis.As there were no metastases to vital organs,posterior thoracic and lumbar spinal decompression+adnexal mass resection+pedicle internal fixation was adopted to achieve local cure and prevent nerve compression.The results of histopathological studies were consistent with the metastasis of GIST.No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site.The patient has no neurological symptoms at present.It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital,and the pathological diagnosis of the mass was GIST.CONCLUSION By reviewing 26 previously reported cases of spinal metastasis in GIST,it was found that spinal metastasis of GIST has become more common in recent years,so the possibility of early spinal metastasis should be recognized.CT and MRI are of great value in the diagnosis of spinal metastatic tumors,and pathological biopsy is the gold standard for the diagnosis of metastatic tumors.It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses,decompressing the spinal canal,and stabilizing the spine.

Surgical treatment of 21 patients with spinal metastases of differentiated thyroid cancer

Background Differentiated thyroid cancer （DTC） is a common primary cancer for spinal metastases （SM）.The treatments for DTC spinal metastases （SM） have evolved from simple surgery and radiotherapy to a multidisciplinary comprehensive therapeutic strategy of combined spinal surgery,general surgery,radiotherapy,nuclear medicine and endocrinology.The purpose of this study was to discuss the efficacy and prognosis associated with different surgical treatments of SM patients with DTC.Methods A total of 21 consecutive patients with SM of DTC that were treated between 1999 and 2013 were studied.Biopsy was routinely performed to achieve the pathological diagnosis before treatment.Three patients underwent total spondylectomy intralesionally or piecemeally,and 18 had curettage.Postoperative recurrence and survival times were analyzed by the Kaplan-Meier methods.Results Nineteen patients （90％） had an average of 42.7 months （range,7-170 months） follow-up.The median visual analogue scale for pain reduced from 5 points to 1 point （P ＜0.01）,and the median Karnofsky performance score increased from 70 to 90 points after surgery （P ＜0.01）.Seventeen patients with neurological deficits attained improvements after surgeries,of at least one level according to the Frankel classification （P ＜0.01）.Eight patients with curettage had recurrence.Four patients died of DTC,12 patients lived with disease,and three patients were disease-free.No significant effects on postoperative recurrence or survival were observed between surgery combined with conservative treatment,total spondylectomy,the number of bone metastases and visceral metastasis.Conclusions DTC-SM have a relatively favorable prognosis,and curettage and stabilization can effectively relieve the pain and improve the quality of life and neurological status of the patients.For patients with Tomita scores of ＜3,total spondylectomy may have better clinical outcomes.Comprehensive therapeutic strategies including surgery,radioiodine,external beam radiation therapy and embolization should be considered for most patients.

Percutaneous transforaminal endoscopic decompression combined with percutaneous vertebroplasty in treatment of lumbar vertebral body metastases:A case report

BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.

Kyphoplasty versus vertebroplasty for the treatment of malignant vertebral compression fractures caused by metastases： a retrospective study

Background There are few comparative studies regarding kyphoplasty （KP） and vertebroplasty （VP） for the treatment of painful vertebral compression fractures （VCF） in patients with cancer. The purpose of this study is to retrospectively compare KP with VP in pain improvement, cement leakage incidence, and the cost of treatment of malignant VCE Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases, treated with KP in 42 cases and VP in 38. Visual analog scale （VAS） scores were collected pre-operatively, post-operatively, at 1 month, 6 months, and 1 year after treatment. Cement leakage was identified using fluoroscopy and CT scan. Total cost per patient was also collected. Results There was a significant difference between the pre- and post-operative VAS scores （7.4＋2.0 to 3.8＋1.6, P 〈0.001 in the KP group; 6.7＋2.4 to 3.7＋1.4, P 〈0.001 in the VP group）, and was maintained at 1-year follow-up （3.2＋1.4 in the KP group, 3.1＋1.3 in the VP group）. However, the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively （P 〉0.05）. The incidence of cement leakage in the KP group was lower than that of the VP group （16.9% （14/83） vs 30.3% （23/76）, P 〈0.05）. However, none of the patients developed any symptoms. The length of postoperative hospital stay in the VP group was shorter than that of the KP group （（2.4＋1.3） vs （5.3＋1.9） days, P 〈0.05）. Total hospital cost in the KP group was much higher than that of the VP group （RMB Yuan 8 492_＋3 332 vs RMB Yuan 3 173~1 341, P〈0.01）. Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF. KP provides no greater degree of pain improvement. KP is associated with a lower rate of cement leakage compared with VP. VP is associated with lower cost and shorter postoperative hospital stay in China.