Metastatic spinal metastasis to the spine due to endometrial carcinoma

1. Metastatic endometrial
adenocarcinoma to the
spine
Upper Chesapeake Medical Center Spine Conference
Friday April 7, 2017

2. 64 year old woman CC: B lower extremity
pain
HPI: 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,
hydronephrosis
MEDS: Depakote, Lortab, Batrim
SH: clerical
Exam: 5’6” 200lb, L hip pain 2/5 with pain

5. Skeletal met of unknown origin
85% 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.

6. Reasons for radiographic workup:
1.R/O isolated sarcoma of bone
2.Easier biopsy site
3.Need for preoperative embolization
RENAL CELL
4. avoid biopsy
5.Working diagnosis helps the pathologist
6. 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

7. Laboratory Tests:
Serum calcium (ionized)
SPEP
PSA
ESF
CRP (noncardiac)
?LFT
CEA

9. METASTASIS

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13. 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.

14. Valsalva maneuver
Antonio Maria Valsalva(1666-1723)
Bologna,Italy anatomist
Maneuver expelled pus from the inner ear

15. Most Common Mets
to Bone
(about 70% all metastatic disease eventually involves bone metastasis)
• Breast
• Prostate
• Lung
• Renal
• Hematopoietic tumors
• Thyroid

32. Why
is
the
cauda
equina
still
deviated
away
from the
tumor?

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

35. 100 patients randomized double blind

44. ?

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

47. 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

49. UCMC SPINE CONFERENCE
APRIL 7, 2017

50. CASE 1
GJ
S17-1390
T-12 TUMOR/PARASPINAL
MASS

67. thanks