Zagzoog Nirmeen, Ra Greta, Koziarz Alex, Provias John, Sommer Doron, Almenawer Saleh A, Reddy Kesava
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery. 2017 Apr 1;80(4):219-223. doi: 10.1093/neuros/nyw157.
Myxoid liposarcoma is not an uncommon form of sarcoma. However, it usually affects the lower extremity long bones. Scapular involvement is extremely rare, as is a metastasis to the parasellar region. We present a case of liposarcoma of the skull base originating in the scapular region and metastasizing to the sellar and parasellar regions and provide a review of the pertinent literature.
A 43-year-old female patient diagnosed with left scapular myxoid liposarcoma was treated with surgical resection. She had clear resection margins and was treated pre- and postoperatively with radiotherapy to the region. She remained asymptomatic for 2 years following surgery, after which she abruptly developed diplopia with right lateral gaze. There were no symptoms of raised intracranial pressure or impaired vision. Her examination was normal apart from complete right sixth nerve palsy. Imaging studies of the brain showed a large mass in the clivus eroding into the floor of the sella, encircling the right internal carotid artery in the cavernous sinus. The mass also displaced the sellar contents superiorly. An endonasal, endoscopic skull base approach was undertaken, and a subtotal resection was performed in an effort to avoid multiple cranial nerve pareses.
Our literature search revealed that this case report is the first to document liposarcoma metastasis to the skull base originating from the scapular region. Subtotal surgical resection resulted in minimal improvement of the patient's sixth nerve palsy. Postoperative radiation was undertaken. A multidisciplinary approach on an individual patient basis is recommended.
黏液样脂肪肉瘤是一种并不罕见的肉瘤类型。然而，它通常累及下肢长骨。肩胛骨受累极为罕见，鞍旁区域转移同样罕见。我们报告一例起源于肩胛骨区域并转移至鞍区和鞍旁区域的颅底脂肪肉瘤病例，并对相关文献进行综述。
一名43岁女性患者被诊断为左肩胛骨黏液样脂肪肉瘤，接受了手术切除治疗。手术切缘清晰，术后对该区域进行了放疗。术后2年她一直无症状，之后突然出现右侧凝视时复视。无颅内压升高或视力受损症状。除右侧外展神经完全麻痹外，她的检查结果均正常。脑部影像学检查显示斜坡有一巨大肿块，侵蚀至鞍底，在海绵窦内环绕右侧颈内动脉。该肿块还将鞍内结构向上推移。采用鼻内镜下颅底入路，进行了次全切除，以避免多条颅神经麻痹。
我们的文献检索显示，本病例报告是首例记录起源于肩胛骨区域的脂肪肉瘤转移至颅底的病例。次全手术切除使患者的外展神经麻痹仅得到轻微改善。术后进行了放疗。建议针对个体患者采取多学科方法。
