Department of Medical and Surgical Specialties, Division of Neurosurgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Int J Neurosci. 2023 Dec;133(10):1124-1128. doi: 10.1080/00207454.2022.2052066. Epub 2022 Apr 3.
Purpose/aim of the study:Central nervous system (CNS), skull, and vertebral metastases from anal squamous cell carcinoma (SCC) are an exceedingly rare entity. We report the first case of multiple vertebral metastases from a primary anal SCC with the aim of define a target therapeutic strategy. We present the case of a 68-year-old male admitted to our hospital for acute exacerbation chronic low back pain and left L2 radiculopathy. His medical history included the diagnosis of a human papilloma virus related, moderately differentiated anal SCC (cT3N0M0-stage IIB), treated with standard chemoradiotherapy regimen two years earlier. Spinal magnetic resonance imaging revealed an isolated solid lesion of the L2 vertebral body. After the surgical removal, histopathological examination confirmed the diagnosis of moderately differentiated SCC. At 1-month radiological follow-up, two new lesions at the level of T7 to T11 were identified. Additional chemotherapy and radiotherapy for metastatic localization of L2, T7, and T11 were administered. Two-year follow-up demonstrated a radiologically and clinically well-controlled disease. To supplement our case, a systematic literature review on the CNS, skull, and vertebral metastases and their treatments has been performed. Despite several proposed guidelines for the management of vertebral metastases, at present, a universally accepted treatment strategy for vertebral metastases from anal SCC has not been defined. Based on our clinical experience and literature review, in case of vertebral metastases from anal SCC, a prompt and aggressive, local and systemic, and multimodal treatment of the vertebral lesions may be paramount to improve the patient outcomes.
原发于肛门的鳞癌（SCC）发生中枢神经系统（CNS）、颅骨和脊椎转移极其罕见。我们报道首例原发于肛门 SCC 的多节段脊椎转移病例，旨在确定目标治疗策略。我们报告了 1 例 68 岁男性病例，因慢性腰痛急性加重和左侧 L2 神经根病就诊于我院。患者病史包括人乳头瘤病毒相关的、中分化肛门 SCC（cT3N0M0 期 IIB）诊断，2 年前接受标准放化疗。脊柱磁共振成像显示 L2 椎体孤立性实体病变。手术切除后，组织病理学检查证实为中分化 SCC。1 个月影像学随访时，发现 T7 至 T11 水平有 2 个新病变。对 L2、T7 和 T11 的转移灶进行了额外的化疗和放疗。2 年随访显示疾病在影像学和临床上均得到良好控制。为了补充我们的病例，对 CNS、颅骨和脊椎转移及其治疗进行了系统的文献复习。尽管有针对脊椎转移治疗的若干建议指南，但目前尚无普遍接受的治疗原发于肛门 SCC 的脊椎转移的策略。根据我们的临床经验和文献复习，对于原发于肛门 SCC 的脊椎转移，及时采取积极的局部和全身、多模式的脊椎病变治疗可能对于改善患者预后至关重要。
