Long-term follow-up after en bloc resection and reconstruction of a solitary paraganglioma metastasis in the first lumbar vertebral body: a case report

Richter, A.; Halm, H.; Lerner, Thomas; Liljenqvist, Ulf; Quante, Markus

doi:10.1186/1752-1947-5-45

Cited by 12 publications

(18 citation statements)

References 22 publications

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“…Mertens demonstrated the successful regression and palliation of metastases of paraganglioma with chemotherapy, particularly with combined cyclophosphamide, vincristine and dacarbazine (13). However, there were also a number of disappointing reports on chemotherapy for this type of tumor (8,11,12,15). In our study, 6 patients with primary paraganglioma only underwent surgery and the follow-up showed good outcomes and no recurrence.…”

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confidence: 78%

Paragangliomas of the spine

Lu²,

Dai³

2015

Turkish Neurosurgery

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Clinical presentations and courses of spinal paragangliomas are varied, and there are no standard principles of treatment to date (1,8). In this article, we report the clinical data of 7 consecutive cases with complete medical records and followup results that were treated in our institutions, in an attempt to explore the diagnosis, treatment and prognosis. █ mATERIAl and mEThODSA retrospective analysis was performed in 7 patients with spinal paraganglioma in our hospital from October 2000 to October 2011. No patient was lost in the follow-up period. There were 6 cases of primary spinal paraganglioma and one case █ INTRODUCTION P aragangliomas are rare tumors that arise from the paraganglia cells of the neuroendocrine system and account for 0.3% of all neoplasms (2,4). More than 80% of this kind of tumor develops within or near the glomus jugulare and carotid body. Paragangliomas of spinal involvement are extremely rare. Primary spinal paragangliomas usually take the form of intradural compression of the cauda equina or intra/extradural compression of the thoracic and cervical spinal cord (1). The first case of metastatic spread of a paraganglioma to the spine was reported in 1948. So far, less than 30 cases of spinal metastases by paragangliomas have been reported in English.AIm: Paragangliomas of the spine are rare tumors. Clinical presentations and courses of spinal paragangliomas are varied, and there are no standard principles of treatment to date. The purpose of this study was to explore the diagnosis, treatment and prognosis of spinal paragangliomas. mATERIAl and mEThODS:The clinical data of 7 consecutive cases, with complete medical records and follow-up results that were treated in our institutions from October 2000 to October 2011, was retrospectively reviewed.RESUlTS: There were 6 males and 1 female with a mean age of 40 years (range, 16-61). The follow-up period ranged from 40 to 98 months (mean, 72 months). Of the 6 primary spinal paragangliomas, one lesion was in the cervical intradural extramedullary space, one in the thoracic epidural space and four in the lumbar intradural extramedullary space. All tumors were totally resected and no recurrence was detected during the follow-up period. Of the metastatic case, the lesion of the spine was located in the first lumbar epidural space and vertebra. The patients underwent surgical resection two times with radiotherapy, but the tumor recurred and the patient suffered from the paraplegia of lower limbs and urine and stool incontinence during the follow-up period. No patient died.CONClUSION: Spinal paragangliomas are rare lesions and seldom considered in the presurgical differential diagnosis due to its rarity and non-specific clinical symptoms and imaging features. Clinical follow-up was necessary to determine the outcome. Complete resection is necessary to prevent recurrence. The role of radiotherapy in the management of these lesions needs further assessment.

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confidence: 78%

Paragangliomas of the spine

Lu²,

Dai³

2015

Turkish Neurosurgery

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“…The strategy must be carried on the adequate study of the tumors according to the Tokuhashi and Tomita scoring system. Alexander Richter et al [6] had reported TES and reconstruction of a solitary spinal MPG in L1 vertebral body with a follow-up time for 10 years which indicated the significance of TES. As a result, with surgical and internal fixation techniques rapidly improving, total resection, even TES when possible, is necessary to treat spinal MPG, especially solitary lesion, to achieve satisfying results.…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy with a total of 30-50 Gy had been reported to be helpful for the treatment of spinal MPG [2,6,12,15,30]. Mertens et al [28] had reported initial chemotherapy including cyclophosphamide, vincristine and dacarbazine could alleviate symptoms at metastatic sites.…”

Section: Discussionmentioning

confidence: 99%

“…It is a slow-growing tumor that often presents as a painless mass in the fifth or sixth decade of life [4], and often recurs after incomplete surgical resection. Although regarded as benign in nature, PG possesses metastatic possibility which is a marker of malignant transformation [5,6] as there are no molecular or cellular markers existing for determining whether PG is malignant [7][8][9]. Metastatic PGs (MPG) are among the solid tumors that most frequently spread to the skeleton, with spine being the most frequently affected site [10].…”

Section: Introductionmentioning

confidence: 99%

“…Spinal MPG was uncommon and sporadically reported in the English literature [2][3][4][5][6][11][12][13][14][15][16][17] with no case series study. Spinal lesions could cause bone destruction or compression of the spinal cord, clinically manifesting as pain or neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

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Treatment and outcome of metastatic paraganglioma of the spine

et al. 2017

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Background Spinal metastatic paraganglioma (MPG) is rare and only reported in individual case reports. The low incidence makes it difficult to define appropriate therapy and prognosis. Our study illustrated the largest series to discuss the possible treatment and outcomes of patients with spinal MPG. Methods A retrospective study of 15 patients with spinal MPG who were surgically treated between 2005 and 2014 was performed. Three surgical modalities were applied, and radiotherapy and chemotherapy were utilized as adjuvant therapy. Results The mean patients age was 40.9 (range 23-58) years. The period between primary surgery and spinal metastasis averaged 8.2 (0.5-15) years. Lesions were mainly located in cervical spine (2), thoracic spine (8), lumbar spine (3), and sacrum (2). The mean follow-up period was 35.0 months. Lesion progression was detected in nine patients, whereas five patients (33.3%) passed away. For solitary spine, multiple bone and both bone and nonosseous metastasis cases, the mean progression-free survival was 41 (range 9-56), 22.5 (range 12-38) and 8.3 (range 3-18) months, respectively. Conclusions The cases presented in the current study highlight the crucial role of surgery. Total en bloc for solitary spinal MPG could result in a satisfying prognosis and piecemeal total resection with postoperative radiotherapy could be an alternative therapy. Radiotherapy and chemotherapy were advocated, especially for the multiple metastasis.

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