Lin Bin, Chen Zhi-Wen, Wang Ning, Guo Zhi-Min, Liu Hui, Zeng Ming
Department of Orthopaedics, 175th Hospital of PLA, Fujian, China.
Orthopedics. 2012 Apr;35(4):e610-4. doi: 10.3928/01477447-20120327-38.
This article describes a rare malignant spinal tumor successfully treated with total en bloc spondylectomy via a posterior approach. The purpose of this study was to emphasize the occurrence of primary histiocytic sarcoma in the lumbar spine. Histiocytic sarcomas are rare, malignant neoplasms of the lymphohematopoietic system that usually occur in the skin, lymph nodes, and intestinal tracts. Primary spinal column histiocytic sarcoma is rare. To the authors' knowledge, no reports have been published of treating this tumor with total en bloc spondylectomy.A 27-year-old woman presented with a 2-month history of intermittent low back pain and right lower extremity pain. Magnetic resonance imaging and computed tomography (CT) revealed a lumbar vertebra tumor. Positron emission tomography/CT showed focal accumulation in the tumor site. The patient was diagnosed with a histiocytic sarcoma based on biopsy findings and underwent total en bloc spondylectomy of L3 and reconstruction via a posterior approach. The patient maintained normal neurologic function, and the pain was lessened. No major complications occurred. No radiotherapy or chemotherapy was administered postoperatively, and no local tumor recurrence or distant metastases existed at 2-year follow-up.The diagnosis of histiocytic sarcoma relies predominantly on the verification of histiocytic lineage and the exclusion of other, poorly differentiated, large-cell malignancies by immunohistochemical stain. Total en bloc spondylectomy at L3 via a posterior approach can be performed safely and is an important approach in the treatment of selected spinal tumors.
本文描述了一例通过后路整块脊椎切除术成功治疗的罕见恶性脊柱肿瘤。本研究的目的是强调腰椎原发性组织细胞肉瘤的发生情况。组织细胞肉瘤是淋巴造血系统罕见的恶性肿瘤，通常发生于皮肤、淋巴结和肠道。原发性脊柱组织细胞肉瘤罕见。据作者所知，尚无关于采用整块脊椎切除术治疗该肿瘤的报道。一名27岁女性，有2个月间歇性下腰痛和右下肢疼痛病史。磁共振成像和计算机断层扫描（CT）显示腰椎有肿瘤。正电子发射断层扫描/CT显示肿瘤部位有局灶性聚集。根据活检结果，该患者被诊断为组织细胞肉瘤，并通过后路进行了L3整块脊椎切除术及重建。患者神经功能保持正常，疼痛减轻。未发生重大并发症。术后未进行放疗或化疗，2年随访时无局部肿瘤复发或远处转移。组织细胞肉瘤的诊断主要依靠组织细胞谱系的验证以及通过免疫组化染色排除其他低分化大细胞恶性肿瘤。通过后路对L3进行整块脊椎切除术可安全实施，是治疗特定脊柱肿瘤的重要方法。
