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Metastatic Leiomyosarcoma of the Spine Updates in Management and Surgical Strategy

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DOI: 10.4236/ojmn.2013.34018    3,251 Downloads   5,183 Views   Citations

ABSTRACT

Introduction: Leiomyosarcoma (LMS) is a rare malignant tumor arising from the smooth-muscle cells which rarely metastasizes to the bone and even less is found in the spine as a primary localization. In this article the authors describe a case of a peculiar localization of this neoplasm in the upper thoracic spine which required a tailored surgical treatment. Case Report: A 52-year-old female presented with an 8 weeks' history of gradually worsening myelopathy and sensory level in the upper thoracic spine. Pre-operation MRI scans showed an invasive mass neoplasm at T3 and T4 levels involving the vertebral bodies and pedicles with a significant cord compression. A 360° two-step approach was performed. The first operation consisted in a T1-T4 decompressive laminectomy with a sub-total tumor resection and pedicle fixation extending from C7 to T5. A second surgical step was performed through an anterior approach in order to improve the amount of tumor removal. Instrument fixation assured the stabilization of the spinal segment. Post-operative scans demonstrated an optimal decompression. Neurological symptoms gradually improved, and the patient benefitted from a gradual reversion of previous symptomatology and could go back to her previous life. Conclusion: LMS represents a challenging tumor due to an extremely aggressive behavior and a considerably high rate of recurrence which requires a tailored approach in terms of surgical strategy and follow-up. A exhaustive review of literature was performed in the attempt to rationalize a surgical strategy and correct management of this extremely rare neoplastic lesion.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

G. Maimone, N. Nicassio, I. Malik and M. Cambria, "Metastatic Leiomyosarcoma of the Spine Updates in Management and Surgical Strategy," Open Journal of Modern Neurosurgery, Vol. 3 No. 4, 2013, pp. 98-103. doi: 10.4236/ojmn.2013.34018.

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