Gaydarski Lyubomir, Kolev Danny, Popov Deyan, Metodiev Dimitar, Georgiev Georgi P, Landzhov Boycho, Hadzhiyanev Asen
Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, BGR.
Department of Neurosurgery, University Hospital "Saint Ivan Rilski", Sofia, BGR.
Cureus. 2024 Oct 17;16(10):e71676. doi: 10.7759/cureus.71676. eCollection 2024 Oct.
Melanoma is an aggressive cancer with a high potential for metastasis, commonly spreading to organs such as the lungs, brain, liver, and bones. Bone metastases, particularly to the spine, are a frequent complication and can result in severe pain, spinal cord compression, and neurological deficits. Prompt diagnosis and treatment are critical, though managing spinal metastases from melanoma poses significant challenges. We present the case of a 41-year-old man with a history of malignant melanoma who developed acute paraplegia following a pathological fracture of the third thoracic vertebra. The patient reported rapidly worsening back pain and loss of motor function in the lower extremities. Magnetic resonance imaging revealed a metastatic lesion in the third thoracic vertebrae, causing spinal cord compression. An emergency open laminectomy with partial tumor resection and vertebroplasty was performed to decompress the spinal cord and stabilize the spine. Postoperative recovery was remarkable, with significant improvement in motor and sensory function within 48 hours. Histopathological and immunohistochemical analysis confirmed the metastatic melanoma diagnosis. This case highlights the challenges of diagnosing and managing acute paraplegia caused by spinal metastases in melanoma patients. Early recognition of symptoms and timely intervention are crucial to improving neurological outcomes.
黑色素瘤是一种侵袭性癌症，具有很高的转移潜力，通常会扩散到肺部、大脑、肝脏和骨骼等器官。骨转移，尤其是脊柱转移，是一种常见的并发症，可导致严重疼痛、脊髓压迫和神经功能缺损。及时诊断和治疗至关重要，尽管处理黑色素瘤的脊柱转移带来了重大挑战。我们报告了一例41岁男性患者，有恶性黑色素瘤病史，在第三胸椎病理性骨折后出现急性截瘫。患者报告背痛迅速加重，下肢运动功能丧失。磁共振成像显示第三胸椎有一个转移瘤，导致脊髓受压。进行了急诊开放性椎板切除术、部分肿瘤切除术和椎体成形术，以解除脊髓压迫并稳定脊柱。术后恢复显著，48小时内运动和感觉功能有明显改善。组织病理学和免疫组织化学分析证实了转移性黑色素瘤的诊断。该病例突出了黑色素瘤患者脊柱转移所致急性截瘫的诊断和处理挑战。早期识别症状并及时干预对于改善神经功能结局至关重要。
