Metastatic endometrial adenocarcinoma to the

spineUpper Chesapeake Medical Center Spine Conference

Friday April 7, 2017

64 year old woman CC: B lower extremity painHPI: 2-3 months ago started having flank pain, seen in ER 1/24/17 with urinary frequency dx: R hydroureteronephrosis, s/p R nephrostomy tube insertion, S/P cystoscopy R ureteral biopsy placement of double J stent 2/28/17. pain became severe 3 weeks ago, PCP ordered xrays, admitted through HMH ER 3/5/17 with persistent flank pain, CT in ER revealed lytic lesion L hip, T7, T9 and T12 with spinal cord compression.

PMH: S/P complete hysterectomy UMMS on 4/27/16 stage 2 uterine ca, 30 radiation treatments 27 beam 3 vaginal, cholecystectomy, BTL, depression, HTN, nephrolithiasis, hydronephrosisMEDS: Depakote, Lortab, BatrimSH: clericalExam: 5’6” 200lb, L hip pain 2/5 with pain

Skeletal met of unknown origin85% diagnosis prior to biopsy and biopsy gave Dx in 8%

Rougraff BT, Kneisl JS, Simon MA: Skeletal metastases of unknown origin: A prospective study of a diagnostic strategy. J Bone Joint Surg Am 1993; 75(9):1276-1281.

Reasons for radiographic workup:

1.R/O isolated sarcoma of bone2.Easier biopsy site3.Need for preoperative embolization

RENAL CELL4. avoid biopsy5.Working diagnosis helps the pathologist6. H&P, labs, CXR, whole body scan, CT chest/abd/pelvis with oral/iv contrast will identify the primary site in

85% of all cases

Rougraff BT et al. Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. JBJS Am. 1993; 75:1276-81

Laboratory Tests:

Serum calcium (ionized)SPEP PSAESFCRP (noncardiac)?LFTCEA

METASTASIS

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Oscar Vivien Batson U Penn Prof Anatomy

• Batson OV (1940 Jul). "The function of the vertebral veins and their role in the spread of metastasis". Annals of Surgery 112 (1): 138–49.

Valsalva maneuver

Antonio Maria Valsalva(1666-1723)Bologna,Italy anatomistManeuver expelled pus from the inner ear

Most Common Mets to Bone (about 70% all metastatic disease eventually involves bone metastasis)

• Breast• Prostate• Lung• Renal• Hematopoietic tumors• Thyroid

Why is the cauda equinastill deviatedaway from the tumor?

Patchell study in the Lancet 2005 revealed spinal cord compression from metastatic disease

100 patients randomized double blind

?

IVF 2.5 liters, U/O 225cc, 50cc 5% alb, EBL: 700cc, operative time 2 hours 40 min,

Hilton Mirel’s Classification

SCORE Site of lesion Size (cortex) appearance Pain

1 Upper <1/3 blastic Mild

2 Lower 1/3 – 2/3 mixed Moderate

3 Trochanter >2/3 lytic Functional

SCORE RECOMMENDATION

7 and under observe

8 (15% fx) Use judgement

9 and above fix

UCMC SPINE CONFERENCEAPRIL 7, 2017

CASE 1GJS17-1390T-12 TUMOR/PARASPINAL MASS

thanks