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.

REFERENCES Panelos, J. Voulgaris, S. Michos, E. Doukas, M. Chondrosarcoma of the spine: A rare case with unusual Presentation. Diagnostic Pathology 2006, 1:39 Simmons E, Yinggang Z. Vertebral Tumors Surgical versus Nonsurgical Treatment. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH. Number 443, pp. 233–247 Boriani, S. De lure, F. Bandiera, S. Campanacci, L. Biagini. Di Fiore, M. Bandello, L. Picci, P. Bacchini, P. Chondrosarcoma of the Mobile Spine. Report on 22 Cases. SPINE Volume 25, Number 7, pp 804–812 Chen, T. Benzel, E. Primary Tumors of the Spine. Contemporary Neurosurgey 2006. vol 8 n. 6 QUIRINY, M. GEBHART, M. Chondrosarcoma of the spine: A report of three cases and literature review. Acta Orthop. Belg., 2008, 74, 885-890 Monte, D. Graciolli, J. Koerbel, A. Da Silva, L. Araújo L. MANAGEMENT OF PRIMARY SPINAL CHONDROSARCOMA Report of two cases causing cord compression. Arq Neuropsiquiatr 2004;62(3-B):875-878 SHIVES, T. MCLEOD, R. UNNI, K. SCHRAY, M. Chondrosarcoma of the Spine. Journal of Bone and Join Surgery VOL. 71-A, NO. 8, SEPTEMBER 1989 Vertzyas, N. Cummine, J. Biankin, S. Bilows, M. Chondrosarcoma of the thoracic spine in an 8-year-old child with 12 years follow-up: A case report. Journal of Orthopaedic Surgery 2000, 8(1): 89–92

MUCHAS GRACIAS