Solitary spinous process metastasis: a case report

Abstract

Primary malignant tumors frequently metastasize to bone, third in frequency after liver and lung. [1] Breast, lung, prostate, and kidney cancers have been the most common malignancies with secondary spine involvement.[2] Breast and prostate cancers have particular clinical interest because of the prevalence of these diseases, with about 70% of the patients dying of these cancers having evidence of metastatic bone disease.[3] Bone metastases are also seen in carcinomas of the thyroid, kidney, and bronchus with an incidence of 30-40% at postmortem examination.[3] However, tumors of the gastrointestinal tract rarely (<10%) metastasize to the bone. [3] Sistemik malignitesi olan kemik metastazları vertebral kolonda sık görülür. Metastatik spinal tümörlü hastalar genellikle ağrı ile başvurur. Bazı tümörler asemptomatiktir ve tarama muayeneleri sırasında tespit edilebilir. Spinal metastaz tanısında vertebral kolona yönelik manyetik rezonans görüntüleme (MRG) ile birlikte mevcut olan diğer görüntüleme yöntemleri ve klinik muayene bulguları kullanılmalıdır. Kırk beş yaşında bir erkek bel ağrısıyla başvurdu. Rektum cerrahisi ve radyoterapi öyküsü olan hasta rektum adenokarsinomu için kemoterapi almaktaydı. Üç hafta önce yapılan F18 sodyum florid pozitron emisyon tomografisi taramasında primer cerrahi alan dışında bir anormallik yoktu. Lomber vertebra MRG'sinde L4 spinöz çıkıntı ucunda bir lezyon bulundu. L4 spinöz çıkıntıya eksizyonel biyopsi yapıl-dı. Histolojik inceleme sonucu musinöz adenokarsinom saptandı. İki aylık takipte hastanın bel ağrısı olmadı. İngilizce literatürde daha önce bildirilmiş soliter spinöz çıkıntı metastazına rastlamadık. Geçmişinde kanser öyküsü olan ve nonspesifik spinal ağrısı olan hastalarda spinal metastaz olasılığı dikkatle araştırılmalıdır. Soliter bir spinöz çıkıntı lezyonu dahi spinal metastazın ilk belirtisi olabilir.Anahtar sözcükler: Kemik dokusu; bel ağrısı; neoplazm metastazı; neoplazmlar; omurga.Vertebral column is a common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors usually present with pain. Some tumors are asymptomatic and can be detected during screening examinations. Magnetic resonance imaging (MRI) of the vertebral column with the panel of available imagining methods and the clinical findings should be used for the diagnosis of spinal metastasis. A 45-year-old man was admitted with low back pain. With a history of rectum surgery and radiotherapy, he was on chemotherapy for rectum adenocarcinoma. F18 sodium fluoride positron emission tomography scan which was performed three weeks ago showed no abnormalities other than the primary surgical site. Magnetic resonance imaging of the lumbar vertebrae spine revealed a lesion on the tip of L4 spinous process. Excisional biopsy of L4 spinous process was performed. Histologic examination revealed mucinous adenocarcinoma. He had no low back pain at two-months follow-up. We could not find any solitary spinous process metastasis reported in English literature. Patients with nonspecif...

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