Demirçay Emre, Civelek Erdinç, Demiralay Ebru
Department of Orthopedics and Traumatology, Başkent University, İstanbul Health Application and Research Center, 34662 Altunizade, Üsküdar, İstanbul, Turkey.
Eklem Hastalik Cerrahisi. 2013;24(1):58-61. doi: 10.5606/ehc.2013.14.
Vertebral column is a common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors usually present with pain. Some tumors are asymptomatic and can be detected during screening examinations. Magnetic resonance imaging (MRI) of the vertebral column with the panel of available imagining methods and the clinical findings should be used for the diagnosis of spinal metastasis. A 45-year-old man was admitted with low back pain. With a history of rectum surgery and radiotherapy, he was on chemotherapy for rectum adenocarcinoma. F18 sodium fluoride positron emission tomography scan which was performed three weeks ago showed no abnormalities other than the primary surgical site. Magnetic resonance imaging of the lumbar vertebrae spine revealed a lesion on the tip of L4 spinous process. Excisional biopsy of L4 spinous process was performed. Histologic examination revealed mucinous adenocarcinoma. He had no low back pain at two-months follow-up. We could not find any solitary spinous process metastasis reported in English literature. Patients with nonspecific spinal pain with a previous cancer history should be carefully evaluated for a spinal metastasis. Even a solitary spinous process lesion may turn out to be the initial manifestation of a spinal metastasis.
脊柱是全身恶性肿瘤患者发生骨转移的常见部位。脊柱转移性肿瘤患者通常表现为疼痛。有些肿瘤无症状，可在筛查检查时被发现。脊柱磁共振成像（MRI）结合现有的影像学检查方法和临床症状，应用于脊柱转移瘤的诊断。一名45岁男性因腰痛入院。他有直肠癌手术和放疗史，正在接受直肠癌化疗。三周前进行的F18氟化钠正电子发射断层扫描显示，除了原发手术部位外没有其他异常。腰椎磁共振成像显示L4棘突尖端有一个病变。对L4棘突进行了切除活检。组织学检查显示为黏液腺癌。在两个月的随访中他没有腰痛症状。我们在英文文献中未发现任何关于孤立性棘突转移的报道。有既往癌症病史且伴有非特异性脊柱疼痛的患者应仔细评估是否存在脊柱转移。即使是孤立的棘突病变也可能是脊柱转移的最初表现。
