Presentation
Neck pain and neurologic compression. Patient with multiple metastatic lesions: brain, lung, and intraabdominal. Ovarian mass on CT: CAD? ovarian Ca ?
Patient Data
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Multiple bilateral pulmonary nodules. The pleural spaces are clear. There are multiple bilateral hilar, subcarinal and paratracheal lymph nodes. The largest paratracheal node measures 32mm and the subcarinal node measures 35 mm.
The liver, spleen, adrenals, kidneys pancreas and bowel are normal in appearance. Large para-aortic lymph node measures 34mm.Lytic lesion in the left humeral head is partially imaged. Destructive lytic lesion in the left iliac tuberosity.
T1 destructive mass with compression of the vertebral body with suggestion of associated soft tissue mass resulting in severe canal stenosis. Bilateral L4 pars defects. Lumbar alignment is normal.
CONCLUSION: Multiple lung and bone metastases. T1 vertebral body metastasis appears to have a soft tissue component resulting in severe canal stenosis. This could be further assessed with MRI.
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A T1 corpectomy has been performed, with spacer device between C7 and T2 vertebral bodies. Anterior fusion plate in-situ, with screws in C7 and T2 vertebral bodies. Alignment is anatomical. Surgical emphysema adjacent the operative site. The spinal canal is capacious at all levels.
Partially imaged pulmonary nodules as per CT from previous day.
Case Discussion
This case illustrates a patient with extensive metastatic disease of unknown origin with a metastatic lesion promoting the vertebral body collapse of T1 and consequent compression over the medulla.
In cases like this one, the treatment aims to relieve pain and to reverse neurological symptoms.
Anterior corpectomy (removal of a vertebral body) and stabilization of the symptomatic lesion was proposed and performed. The histology study of the lesion revealed a metastatic poorly differentiated squamous cell carcinoma.
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