Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Neurosurgery. 2011 Apr;68(4):E1160-4; discussion 1164. doi: 10.1227/NEU.0b013e31820ccf90.
Clear-cell chondrosarcoma is a rare subtype of chondrosarcoma. These osseous tumors are most commonly found in the end of long bones. We report a rare case of clear-cell chondrosarcoma of the osseous spine.
A 52-year-old man presented to another institution with a pathologic L1 compression fracture. Intraoperatively, this fracture was discovered to be secondary to a chondrosarcoma involving T12, L1, and L2. He was then referred to our institution for further evaluation and treatment. A 2-stage operation was performed with successful en bloc resection of residual chondrosarcoma with negative margins. The first stage using a posterior approach resulted in placement of pedicle screws from T9 to L4, laminectomies from T12 to L2, and placement of Tomita saws between the thecal sac and the vertebral body at both the T11-12 and L2-3 disc levels. The second stage of the procedure involved a transthoracic, retroperitoneal approach to the thoracolumbar spine. Osteotomies between T11-12 and L2-3 were completed, and the vertebral bodies of T12, L1, and L2 were delivered as an en bloc specimen. The final pathology of the specimen was clear-cell chondrosarcoma with negative margins.
This report discusses a rare occurrence of clear-cell chondrosarcoma in the osseous spine. Aggressive surgical intervention with the goal of en bloc resection of tumor is recommended to promote tumor-free survival.
透明细胞软骨肉瘤是软骨肉瘤的一种罕见亚型。这些骨肿瘤最常见于长骨的末端。我们报告了一例罕见的骨脊柱透明细胞软骨肉瘤病例。
一名 52 岁男性因病理性 L1 压缩性骨折到另一家机构就诊。术中发现该骨折继发于 T12、L1 和 L2 受累的软骨肉瘤。随后他被转诊到我们机构进行进一步评估和治疗。进行了两阶段手术，成功地整块切除了有切缘阴性的残余软骨肉瘤。第一阶段采用后路入路，在 T9 到 L4 之间放置了椎弓根螺钉，在 T12 到 L2 之间进行了椎板切除术，并在 T11-12 和 L2-3 椎间盘水平的硬脊膜囊和椎体之间放置了 Tomita 锯。第二阶段手术采用经胸、腹膜后入路进行胸腰椎。完成了 T11-12 和 L2-3 之间的截骨术，并整块切除了 T12、L1 和 L2 的椎体。标本的最终病理为有切缘阴性的透明细胞软骨肉瘤。
本报告讨论了罕见的骨脊柱透明细胞软骨肉瘤。建议采用积极的手术干预，以整块切除肿瘤为目标，促进无肿瘤生存。
