lecture metastatic endometrial adenocarcinoma to the spine

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Metastatic endometrial adenocarcinoma to the spine

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: 56 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:

R/O isolated sarcoma of boneEasier biopsy siteNeed for preoperative embolization RENAL CELL avoid biopsyWorking diagnosis helps the pathologistH&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): 13849.

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)BreastProstateLungRenalHematopoietic tumorsThyroid

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

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

Hilton Mirels ClassificationSCORESite of lesionSize (cortex)appearancePain1Upper2/3lyticFunctional

SCORERECOMMENDATION7 and underobserve8 (15% fx)Use judgement 9 and abovefix

UCMC spine ConferenceApril 7, 2017

Case 1gjs17-1390T-12 Tumor/paraspinal mass

thanks