Authors :
Dr. Kingshuk Ganguly; Dr. Ashwin Shetty; Dr. Santosh Babu
Volume/Issue :
Volume 8 - 2023, Issue 1 - January
Google Scholar :
https://bit.ly/3IIfn9N
Scribd :
https://bit.ly/3HPbJfN
DOI :
https://doi.org/10.5281/zenodo.7627390
Abstract :
Introduction: Tumour metastasis to the spine
very rarely occurs from an adnexal tumour and an
accurate and fast diagnosis is essential for good patient
management.
Methodology: 52 year old male came with complaints of
mid back pain since 2 months and weakness of bilateral
lower limbs since 3 weeks a with progressive loss of bowel
and bladder control since 3 days noted at presentation.
Patient was previously operated for excision of a mass over
left hand hypothenar region 1 year back which on
histopathological evaluation had showed an eccrine
tumour. XRAYs revealed a T8 compression fracture of the
spine and MRI was done which revealed compression
fracture of T8 vertebra with involvement of posterior
elements and an anterior epidural collection causing canal
stenosis and similar lesions noted in T 7 and T 9 vertebra
with a suspicion of metastasis. Hence a PET scan was done
and showed lytic lesions in multiple vertebral bodies
,posterior elements,left iliac and left SI joint extending to
acetabulum and femoral shaft.Patient was planned for
stabilisation of spine with a vertebral biopsy and patient
underwent a T7 to T11 posterior spinal stabilisation with
polyaxial pedicle screws and biopsy from T8 vertebra.
Postoperatively, the patient was evaluated and paraparesis
recovered and patient was begun on physiotherapy
exercises for faster recovery. The histopathology report
showed features of poorly differentiated metastatic
squamous cell cancer and immunohistochemistry markers
were done which was positive for CK and CK 5 / 6 which
indicated a skin or adnexal tumour. Patient is recovering
postoperatively with mobilisation using KT brace and on a
wheel chair with recovering neurological status.
Results- :An eccrine tumour with metastasis to the
thoracic spine and lesions over pelvic bones was managed
with spinal stabilisation using pedicle screws with biopsy
from the T8 vertebra suggesting an adnexal primary
lesion.
Conclusion- :A rare case of an adnexal tumour metastasis
to the spine can be managed effectively with posterior
spinal stabilisation with partial or complete recovery of
neurological status. Importance of a good history with
early identification using PET scan and an
immunohistochemistry to locate the primary were key
turning points in management of this case
Keywords :
Paraparesis, Eccrine, Tumour, Spine
Introduction: Tumour metastasis to the spine
very rarely occurs from an adnexal tumour and an
accurate and fast diagnosis is essential for good patient
management.
Methodology: 52 year old male came with complaints of
mid back pain since 2 months and weakness of bilateral
lower limbs since 3 weeks a with progressive loss of bowel
and bladder control since 3 days noted at presentation.
Patient was previously operated for excision of a mass over
left hand hypothenar region 1 year back which on
histopathological evaluation had showed an eccrine
tumour. XRAYs revealed a T8 compression fracture of the
spine and MRI was done which revealed compression
fracture of T8 vertebra with involvement of posterior
elements and an anterior epidural collection causing canal
stenosis and similar lesions noted in T 7 and T 9 vertebra
with a suspicion of metastasis. Hence a PET scan was done
and showed lytic lesions in multiple vertebral bodies
,posterior elements,left iliac and left SI joint extending to
acetabulum and femoral shaft.Patient was planned for
stabilisation of spine with a vertebral biopsy and patient
underwent a T7 to T11 posterior spinal stabilisation with
polyaxial pedicle screws and biopsy from T8 vertebra.
Postoperatively, the patient was evaluated and paraparesis
recovered and patient was begun on physiotherapy
exercises for faster recovery. The histopathology report
showed features of poorly differentiated metastatic
squamous cell cancer and immunohistochemistry markers
were done which was positive for CK and CK 5 / 6 which
indicated a skin or adnexal tumour. Patient is recovering
postoperatively with mobilisation using KT brace and on a
wheel chair with recovering neurological status.
Results- :An eccrine tumour with metastasis to the
thoracic spine and lesions over pelvic bones was managed
with spinal stabilisation using pedicle screws with biopsy
from the T8 vertebra suggesting an adnexal primary
lesion.
Conclusion- :A rare case of an adnexal tumour metastasis
to the spine can be managed effectively with posterior
spinal stabilisation with partial or complete recovery of
neurological status. Importance of a good history with
early identification using PET scan and an
immunohistochemistry to locate the primary were key
turning points in management of this case
Keywords :
Paraparesis, Eccrine, Tumour, Spine
