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Gami A, Schilling A, Ehresman J, Sciubba DM. Benign Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:457-476. [PMID: 37452949 DOI: 10.1007/978-3-031-23705-8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign osseocartilaginous tumors of the spine are overall uncommon, representing between 1 and 13% of all primary bone tumors and less than 10% of all spinal tumors. Tumors in this category include osteoblastic lesions such as the related osteoid osteoma and osteoblastoma, and cartilage-forming lesions including osteochondroma, chondroma, and chondroblastoma. Aneurysmal bone cysts, giant cell tumors of bone, and eosinophilic granulomas also comprise benign tumors of the spine arising from bone. There is significant heterogeneity in the epidemiology, molecular biology, imaging features, and optimal treatment of these lesions. For example, osteoid osteoma is characterized by high expression of the cyclooxygenase enzymes, making it amenable to treatment with anti-inflammatory drugs initially, whereas other lesions such as osteoblastoma may require intralesional curettage or en bloc resection sooner. Generally, en bloc resection is preferred when possible to minimize risk of recurrence. Further, some tumors may arise in the setting of syndromic conditions, such as multiple chondromas arising in Ollier disease or Maffucci syndrome, or as part of genetic disorders, such as osteochondromas in the context of hereditary multiple exostosis. These lesions may present with local pain, cause neurological compromise or be discovered incidentally on routine imaging. The Enneking classification and Weinstein-Boriani-Biagini system are routinely used to classify lesions and assist in surgical planning. More novel techniques such as radiofrequency ablation and laser photocoagulation have been applied for the treatment of osteoid osteoma and may have utility in the treatment of other lesion types. A multidisciplinary approach is critical in the management of benign lesions of the spine, and both chemotherapeutic and surgical approaches are routinely used.
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Affiliation(s)
- Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Milon A, Polivka M, Larousserie F, Lot G, Ziza JM, Laredo JD. Locally aggressive monostotic fibrous dysplasia of the cervical spine mimicking malignancy: a case report and literature review. SICOT J 2019; 5:34. [PMID: 31560341 PMCID: PMC6764256 DOI: 10.1051/sicotj/2019024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 11/14/2022] Open
Abstract
We report the case of a 30-year-old woman with histologically proven monostotic fibrous dysplasia of C2 revealed by a pathological fracture of the odontoid process. Radiological investigations showed a ground-glass mineralization of the vertebral body, a centimetric lytic area with poorly defined margins involving the inferior part of the vertebral body and inferior endplate and a fracture through an osteolytic area in the base of the odontoid process. Owing to the vertebral instability, a surgical procedure combining C0-C5 fixation and posterior bone grafting was performed. The surgical biopsy was inconclusive and pathological confirmation was finally obtained through a percutaneous needle biopsy under fluoroscopic guidance. At 26-month follow-up, the patient still experienced mild persistent cervical posterior neck pain and stiffness possibly related to a C5-6 laxity below the intervertebral fixation. This case combines three radiological findings, which are unusual in fibrous dysplasia: monostotic presentation involving the spine, some aggressive radiographic features, and a pathological fracture.
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Affiliation(s)
- Audrey Milon
- Department of Radiology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
| | - Marc Polivka
- Department of Pathology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
| | - Fréderique Larousserie
- Department of Pathology, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Ophtalmologique de Rothschild, 29 rue Manin, 75019 Paris, France
| | - Jean-Marc Ziza
- Department of Rheumatology, Hôpital La Croix Saint-Simon, 125 rue d'Avron, 75020 Paris, France
| | - Jean-Denis Laredo
- Department of Radiology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
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Nuñez JH, González-Tartière P, Erimeiku F, DE Frutos AG, Ramírez M. Surgical Treatment of Cervical Spine Fibrous Dysplasia: Case Report and Literature Review. Int J Spine Surg 2019; 12:659-664. [PMID: 30619668 DOI: 10.14444/5082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Fibrous dysplasia (FD) is an uncommon benign intramedullary fibro-osseous lesion. Cervical spine compromise is rare with only cases reported. Currently, the natural history of cervical FD is poorly understood, and its treatment remains controversial. Methods A review of the literature was performed to analyze and discuss the management of cervical FD through a case report and literature review. Results Cervical FD is a rare benign pathology. Clinical presentation is usually casual or only clinical pain. Computed tomography (CT)-guided percutaneous biopsy is a safe and effective technique for evaluation of spinal lesions; however, the accuracy of the preoperative biopsy findings has been disappointing. Although all treatments are valid, no one has been demonstrated to be better. Our proposed treatment, a corpectomy and fixation with a titanium mesh cage filled with allograft bone and an anterior cervical plate, showed good results. Conclusions The rarity of cervical FD and the lack of detailed reports with long-term follow-up periods complicate the research on the optimal treatment approach in these cases, but apparently all are valid for pain control. In our case, a corpectomy and fixation with a titanium mesh cage filled with allograft bone and an anterior cervical plate was carried out and showed good results. We submit this surgery option to be considered in these rare type of injuries.
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Affiliation(s)
- Jorge H Nuñez
- Department of Orthopedic Surgery and Traumatology, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Spine Unit, Department of Orthopedic Surgery, University Hospital of Mutua Terrasa, Barcelona, Spain
| | | | - Frank Erimeiku
- Department of Orthopedic Surgery and Traumatology, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Manuel Ramírez
- Spine Unit, University Hospital of Vall d'Hebron, Barcelona, Spain
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Abstract
The purpose of this paper is to present an overview of the imaging features of the most prevalent benign bone tumors involving the spine. Benign tumors of the osseous spine account approximately for 1% of all primary skeletal tumors. Many lesions exhibit characteristic radiologic features. In addition to age and location of the lesion, radiographs are an essential step in the initial detection and characterization but are limited to complex anatomy and superposition. CT and MR imaging are often mandatory for further characterization, assessment of local extension and guiding biopsy.
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Primary tumors of the spine: a review of clinical features in 438 patients. J Neurooncol 2015; 121:513-20. [PMID: 25637321 DOI: 10.1007/s11060-014-1650-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/26/2014] [Indexed: 12/14/2022]
Abstract
Primary spinal tumors are rare. Current knowledge on this subject is therefore limited due to the lack of study with large cohort. This study is prompted to share our data on clinical profiles of primary spinal tumors collected from a large series of patients. Clinical manifestations of 438 consecutive patients were summarized retrospectively with statistical analysis. In the spine, benign tumor is more common than malignant. The most prevalent tumor is giant cell tumor. Tumors predominately occur between the age of 18 and 59 and the risk of malignancy increases significantly after 40. Main symptoms include local pain and neurological symptoms with frequent occurrence of neurological deficits and pathological fracture. Pain is caused by tumor expansion, pathological fracture and nerve entrapment. Occurrence of neurological deficits is significantly related to patent's age and the region of involvement. Giant cell tumor is associated with the highest incidence of neurological fracture with significance. Duration of symptom is 6 months on average. The most affected region is the cervical spine, followed by the thoracic and the lumbar spine. Tumors at the sacrum and coccyx are more likely to be malignant. Malignant tumors have significantly higher incidence of involvement at multiple levels than benign tumors. This study contributes by improving our understanding of this rare clinical entity.
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Kaloostian PE, Gokaslan ZL. Surgical management of primary tumors of the cervical spine: surgical considerations and avoidance of complications. Neurol Res 2014; 36:557-65. [DOI: 10.1179/1743132814y.0000000367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
STUDY DESIGN Eight cases of fibrous dysplasia (FD) of the mobile spine treated surgically at the same center were retrospectively reviewed. OBJECTIVE The study focuses on the issues concerning the diagnosis of FD and the outcome of conventional surgical techniques (resection or curettage) and vertebroplasty in the treatment of spinal FD lesions. SUMMARY OF BACKGROUND DATA Surgical excision or curettage is considered the standard treatment of spinal FD, whereas vertebroplasty is also performed occasionally. METHODS Between January 2005 and October 2010, 8 consecutive patients with spinal FD underwent conventional surgery (6 cases) or combined with vertebroplasty (2 cases). Before surgery, 4 patients underwent percutaneous computed tomography-guided biopsy, whereas 3 had incorrect histopathological diagnosis. In each of the 8 cases, the final pathological diagnosis was established after their open surgery. RESULTS Pain relief was observed postoperatively in all patients. Three patients with neurological impairment became symptom-free after surgery. No cement extravasation was observed. Screw loosening and allograft resorption were observed in 1 case each. Signs of radiological improvement (filling of lytic lesions or thickening of the bone cortex surrounding the lesions) were not detected in any case. CONCLUSION The radiological features of spinal FD may be atypical. The rate of correct preoperative pathological diagnosis by computed tomography-guided biopsy was low for patients with suspected spinal FD. Vertebroplasty is probably a valuable therapeutic option for spinal FD with pathological fractures. Limited decompression and stability with vertebroplasty might be recommended for patients with neurological deficits.
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Ropper AE, Cahill KS, Hanna JW, McCarthy EF, Gokaslan ZL, Chi JH. Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery 2012; 69:1171-80. [PMID: 21725252 DOI: 10.1227/neu.0b013e31822b8107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Primary vertebral tumors, although less common than metastases to the spine, make up a heterogeneous group of neoplasms that can pose diagnostic and treatment challenges. They affect both the adult and the pediatric population and may be benign, locally aggressive, or malignant. An understanding of typical imaging findings will aid in accurate diagnosis and help neurosurgeons appreciate anatomic subtleties that may increase their effective resection. An understanding of the histological similarities and differences between these tumors is imperative for all members of the clinical team caring for these patients. In this first review of 2 parts, we discuss the epidemiological, histological, and imaging features of the most common benign primary vertebral tumors-aneurysmal bone cyst, chondroma and enchondroma, hemangioma, osteoid osteoma, and osteoblastoma-and lesions related to eosinophilic granuloma and fibrous dysplasia. In addition, we discuss the basic management paradigms for each of these diagnoses. In combination with part II of the review, which focuses on locally aggressive and malignant tumors, this article provides a comprehensive review of primary vertebral tumors.
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Affiliation(s)
- Alexander E Ropper
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Lee SH, Han IH, Kang DW, Choi BK. Cervical fibrous dysplasia presenting as a pathologic fracture in an older patient. J Korean Neurosurg Soc 2011; 50:139-42. [PMID: 22053236 DOI: 10.3340/jkns.2011.50.2.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/25/2011] [Accepted: 08/08/2011] [Indexed: 12/26/2022] Open
Abstract
Vertebral involvement of fibrous dysplasia (FD) is rare, especially in the cervical spine. Moreover, cervical FD presenting as a pathologic fracture in older patients is extremely rare. We report a case of symptomatic cervical FD associated with pathologic fracture in a 63-year-old man. The patient presented with progressive weakness of the left arm and pain in the shoulder and arm. Radiologic studies revealed a collapsed and typical 'ground glass' radiolucency of C4. Multiple lytic lesions involved the odontoid process of C2 and the body, left pedicle, and posterior elements of C4. Combined anterior and posterior decompression and reconstruction were performed. Post-operatively, the histopathologic examination confirmed FD. On the post-operative follow-up examination, the neurologic deficits had completely resolved.
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Affiliation(s)
- Su Heon Lee
- Department of Neurosurgery & Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Imaging appearance of primary bony tumors and pseudo-tumors of the spine. J Neuroradiol 2009; 37:37-50. [PMID: 19781780 DOI: 10.1016/j.neurad.2009.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/13/2009] [Accepted: 08/19/2009] [Indexed: 12/20/2022]
Abstract
We aim to review the imaging appearance of primary bony tumors of the spine and simulating lesions. Benign bone tumors commonly appear as well-circumscribed, slow-growing lesions with a calcified or sclerotic matrix. Malignancy is often aggressive permeative lesions with bone destruction, cortical invasion and associated soft-tissue mass. CT is an excellent imaging modality for characterization of the tumor matrix, exact location, extension and osseous changes, while MR imaging is superior for evaluation of the associated soft-tissue mass, bone marrow infiltration and intraspinal extension. There is a spectrum of pseudotumors that may also involve the spine. The imaging appearance of primary spinal bone tumor in conjunction with the patient's age, gender and lesion location allows a high percentage of correct diagnosis. Imaging plays an important role in diagnosis, characterization and extension of bone tumors of the spine which will help guide therapy.
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