Management of primary spinal chondrosarcoma: report of two cases causing cord compression

Abstract

-Chondrosarcomas are malignant tumors that rarely grow inside the spinal canal. Prognosis depends on histological features, patient's age and surgical margins free from tumor. Response to radio and chemotherapy is poor. Ideal treatment consists of total "en-block" resection, not always achievable due to limitation of location, compromise of stability and risk of inducing neurological deficits. Two cases of spinal chondrosarcoma causing cord compression are reported, located in the cervical and thoracic spine. Microsurgical technique consisted of initial debulking followed by removal of margins until limits free from tumor were obtained. Total resection was accomplished and neurological function improved in both cases. Follow-up has been seven and one year respectively, with no evidence of recurrence and preserved neurological functions. Association between chondrosarcoma and estrogen-dependent tumor has been confirmed in this report. Although "en-block" resection of a chondrosarcoma should be tried whenever possible, tumor fragmentation should be considered in difficult cases, as in the present report, in which a long period free from recurrence with good quality of life can be obtained.KEY WORDS: chondrosarcoma, spinal neoplasms, spinal cord compression, microsurgery. Manejo dos condrosarcomas espinhais primários: relato de dois casos causando compressão medularRESUMO -Os condrosarcomas são tumores malignos, raramente localizados no interior do canal espinhal, com prognóstico dependente do grau histológico do tumor, idade do paciente e margens cirúrgicas livres. Esses tumores apresentam pouca resposta à radio e quimioterapia. O tratamento ideal consiste em ressecção tumoral em bloco, condição particularmente difícil em se tratando de tumores causando compressão medular, devido à localização da lesão, comprometimento da estabilidade axial e necessidade da manutenção ou recuperação da integridade da função neurológica do paciente. Relatamos dois casos de condrossarcomas causando compressão medular, um na coluna cervical e outro na torácica, submetidos a cirurgia com esvaziamento tumoral seguido de remoção das margens, atingindo-se ressecção total e melhora das funções neurológicas em ambos os casos. Um paciente se encontra há 7 anos e outro há 1 ano livre de recorrências, ambos com funções neurológicas preservadas. Associação entre condrosarcoma e tumor dependente de estrógeno é confirmada clinicamente pelo presente estudo. Embora uma ressecção em bloco dos condrossarcomas deva ser tentada quando possível, deve-se considerar uma ressecção com fragmentação tumoral em casos específicos, podendo-se atingir, como demonstrado nos presentes casos, períodos livres de recorrência e longo tempo de sobrevida. PALAVRAS-CHAVE: condrossarcoma, neoplasias medulares, compressão da medula espinhal, microcirurgia.Chondrosarcomas are malignant lesions, which represent the second most common tumor of the skeleton. However, presentation as primary tumor of the spine is extremely rare. These tumors can originate from healthy...

Cervical Chondrosarcoma- Rare Malignancy: A Case Report

“…Thus open biopsies or CT-guided large-core biopsies are required [8]. En-bloc resection remains the treatment of choice for spinal chondrosarcoma [2,[9][10][11]. In patients where it is not feasible due to proximity to vital neurovascular structures of spine, piece-meal removal is recommended but assurance of margins free from tumour must be obtained [9,11].…”

“…En-bloc resection remains the treatment of choice for spinal chondrosarcoma [2,[9][10][11]. In patients where it is not feasible due to proximity to vital neurovascular structures of spine, piece-meal removal is recommended but assurance of margins free from tumour must be obtained [9,11]. Local recurrence is common in patients with piecemeal or intralesional excisions [2].…”

Spinal Cord Compression in a Patient With Multiple Hereditary Exostoses Caused by Breast Adenocarcinoma Metastatic to Osteochondromas of the Spine

“…24,33,34 This is particularly pertinent since the patient's specimen was estrogen-receptor positive, which suggests that if this patient were to undergo treatment with tamoxifen, there is the possibility that this exogenous antiestrogen agent could stimulate growth of a chondrosarcoma. The role of hormonal therapy for metastatic breast cancer in patients with multiple hereditary exostoses warrants further study as patients with multiple hereditary exostoses have multiple exostoses that all have the potential to degenerate into chondrosarcomas.…”

INTERACTIVE CASE REPORT: Coincidental Chondrosarcoma: A Case Report

“…Tümörlerin çoğunluğu femur ve humerusun proksimal ucu ve gövdede yerleşir. Omur-gada ise en sık torakal vertebra tutulumu izlenir (6). Olgumuzda da torakal vertebra tutulumu mevcuttu.…”