Rao S, Brien H W, Strassle P
Department of Orthopaedics, University of Southern California, Los Angeles.
Clin Orthop Relat Res. 1991 May(266):80-4.
The determination of the etiology of spinal cord compression in cancer patients is essential for appropriate therapy. Patients with metastatic disease are not immune to the development of superimposed nonmalignant disease. Although metastatic epidural compression may occur in up to 9% of breast cancer patients, care must be taken to rule out other nonmetastatic lesions causing compression. The association of concurrent breast carcinoma and a spinal neurilemoma simulating a metastatic lesion seems not to have been previously reported. A neurilemoma was observed in a 50-year-old woman. A neurilemoma suspected to be a metastatic lesion may produce the clinical features of pain, neurologic deficit, and weakness. Differentiation will be aided by roentgenograms, radionuclide bone scans, computed tomography, and possible magnetic resonance imaging. Radiologic differentiation hinges on the recognition and the slow-growing nature and noninvasive boundaries of the nonmalignant lesion. Ultimate verification is by biopsy. Treatment should consist of neurectomy, if severely symptomatic, and stabilization as indicated.
确定癌症患者脊髓压迫的病因对于恰当治疗至关重要。患有转移性疾病的患者并非不会发生叠加的非恶性疾病。尽管转移性硬膜外压迫在高达9%的乳腺癌患者中可能出现，但必须注意排除其他导致压迫的非转移性病变。同时患有乳腺癌和模拟转移性病变的脊髓神经鞘瘤的关联此前似乎未曾有过报道。在一名50岁女性中观察到了神经鞘瘤。疑似转移性病变的神经鞘瘤可能产生疼痛、神经功能缺损和无力等临床特征。X线片、放射性核素骨扫描、计算机断层扫描以及可能的磁共振成像有助于鉴别。放射学鉴别取决于对非恶性病变的识别及其生长缓慢的性质和非侵袭性边界。最终的确诊依靠活检。如果症状严重，治疗应包括神经切除术，并根据情况进行固定。
