Jang Soo Jin, Han Nayoung, Hong Eun Kyeong, Gwak Ho-Shin
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Pathology, National Cancer Center, Goyang, Korea.
Brain Tumor Res Treat. 2022 Apr;10(2):123-128. doi: 10.14791/btrt.2022.0007.
Here, we report a rare case of L3 chordoma progressed to an intradural extramedullary (IDEM) mass and distant metastasis to the fascia lata. A 64-year old female patient presented to a local university hospital due to back pain and received excisional biopsy for a L3 destructive bony lesion. Local radiation therapy was initially administered, assuming a malignancy of unknown origin, but she developed cerebrospinal fluid leakage during adjuvant radiation therapy, which was managed by wound revision and lumbar drainage. As the destructive lesion progressed, she visited our hospital for a second opinion 3 months after the biopsy. After review of outside pathology, we diagnosed the lesion to be a chordoma, and performed a L3 corpectomy with cage and plate fixation. One and a half years later, positron emission tomography and computed tomography (PET-CT) revealed a right tensor fascia lata hypermetabolic lesion. Excisional biopsy confirmed a distant metastasis of the chordoma. One year later, she complained of L2 radiating pain. PET-CT and CT myelogram revealed an IDEM lesion. Surgical excision confirmed the transdural invasion of the chordoma. To our knowledge, this is the first report of an iatrogenic IDEM invasion and distant metastasis to the tensor of the fascia lata by a L3 chordoma.
在此，我们报告一例罕见的L3脊索瘤进展为硬脊膜内髓外（IDEM）肿块并远处转移至阔筋膜的病例。一名64岁女性患者因背痛就诊于当地大学医院，因L3椎体破坏性骨病变接受了切除活检。最初假定为不明来源的恶性肿瘤而给予局部放射治疗，但她在辅助放疗期间出现脑脊液漏，通过伤口修复和腰椎引流进行处理。随着破坏性病变进展，活检3个月后她来我院寻求进一步诊断。复查外院病理后，我们诊断该病变为脊索瘤，并进行了L3椎体次全切除及椎间融合器和钢板固定术。一年半后，正电子发射断层扫描和计算机断层扫描（PET-CT）显示右侧阔筋膜张肌有高代谢病变。切除活检证实为脊索瘤远处转移。一年后，她主诉L2节段放射性疼痛。PET-CT和CT脊髓造影显示有一个IDEM病变。手术切除证实脊索瘤经硬脊膜侵犯。据我们所知，这是首例关于L3脊索瘤医源性IDEM侵犯并远处转移至阔筋膜张肌的报告。
