European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Case Reports
Spinal chordomas dedifferentiated to osteosarcoma: a report of two cases and a literature review.
Chordoma is a rare, locally aggressive neoplasm of the bone that arises from embryonic notochordal remnants. In less than 5 % of cases, chordomas contain a highly malignant sarcomatous component. Because of the rarity of such tumors, little is known about their clinical features and optimal treatment options. Herein, we report two chordoma cases with malignant sarcomatoid areas, consistent with high-grade osteosarcoma in the primary spine lesions, and discuss the presentation and characteristics of this disease. ⋯ Accurate analyses of MRI and positron emission tomography scans should suggest the most representative section for histological assessment. Unlike the treatment of conventional chordomas, the treatment of this disease should include chemotherapy first, followed by en bloc resection and/or carbon-ion radiation.
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Review Case Reports
Gout tophus on an intradural fascicle: a case description.
Case report and review of literature. ⋯ To the best of our knowledge, this is the first report of a gout tophus originating from an intradural fascicle and without any boney attachment or underlying systemic gout. The literature is reviewed and possible pathophysiological mechanisms are discussed.
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Review Case Reports
The occurrence of vascular displacement into intervertebral disc space following the compensated sagittal imbalance of the spine: a case report and review of literature.
It is known that sagittal compensating mechanisms are created for counteracting sagittal imbalance problems; however, they can sometimes be associated with incidents which affect the plan of management. ⋯ The occurrence of vascular displacement into the intervertebral disc space related to lumbar hyperextension, as a compensating mechanism, is a rare incident but can occur. Consequently, when this mechanism presents with abnormal widening of the intervertebral disc space, especially at the low lumbar level, it should raise surgeon's concern about the probability of vascular injury when performing a disc procedure. Thorough investigation with imaging studies and selecting the optimum surgical treatment are warranted.
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Inflammatory pseudotumors (IPTs) are benign lesions with unknown etiology, probably an immunological reaction to a traumatic or an infective insult or sometimes considered as an IgG4-related autoimmune disorder. It can occur as an isolated or multi-centric lesion and are reported to involve almost all parts of the human body. Although lung and orbital IPTs are reported commonly, central nervous system involvement is a rare occurrence. Only seven cases of spinal epidural IPTs have been reported to date. These are clinically and radiologically a diagnosis of exclusion. It is an exclusive histopathological diagnosis. ⋯ We present here a 49-year-old female with 2 months history of progressive weakness in lower limbs, with no history suggestive of any traumatic, infective, inflammatory, or neoplastic pathology. Both clinical and radiological investigations were inconclusive. There was a mass lesion in the epidural space (predominantly in the posterior and right lateral space) at T1-T3 vertebral levels compressing the thoracic spinal cord. Considering the progressive nature of her neurological deficit, an emergency decompressive laminectomies of T1-T3 vertebrae were done with excision of the compressive mass lesion. Histopathological examination showed a rich lympho-plasmacytic cell infiltrates with storiform spindle cells and dense fibrosis, which was diagnostic of IPT. Post-operatively there was a rapid recovery in neurology and she became ambulatory at the end of 2 weeks. The purpose of this case report is to discuss the clinical, histopathological and radiological features, differential diagnosis, management, and prognosis of spinal IPT on the background of relevant literature review.
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Review Case Reports
Surgical management of an osteoblastoma involving the entire C2 vertebra and a review of literature.
The purpose of this study was to evaluate the surgical management of an osteoblastoma involving the entire C2 vertebra. ⋯ Marginal resection remains the best treatment for osteoblastoma of the spine. If tumor tissue surrounds the vertebral artery, the vertebral artery should be mobilized and the surrounding tumor mass excised.