Limits...
Merkel Cell Spinal Metastasis: Management in the Setting of a Poor Prognosis.

Goodwin CR, Mehta AI, Adogwa O, Sarabia-Estrada R, Sciubba DM - Global Spine J (2015)

Bottom Line: The surgical management for MESCC depends on pathology.Three weeks postoperatively, the patient re-presented with new-onset weakness and widespread metastatic spinal disease with epidural compression at the T8 level.Six weeks postoperatively, he was placed in hospice care.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

ABSTRACT
Study Design Case report. Objective Merkel cell carcinoma is an aggressive neuroendocrine carcinoma with a poor prognosis. Metastatic epidural spinal cord compression (MESCC) is a debilitating disease causing neurologic deficits. The surgical management for MESCC depends on pathology. Methods We report a case of Merkel cell carcinoma of the spine and evaluate the treatment paradigms utilized in the prior reports. Result A 76-year-old man with a history of Merkel cell carcinoma presented with 2-week history of progressive difficulty ambulating and a solitary T5 epidural mass encasing the spinal cord. The patient underwent a T5 corpectomy with cage placement and T3 to T7 posterior fusion with postoperative neurologic improvement and a return to ambulation. Three weeks postoperatively, the patient re-presented with new-onset weakness and widespread metastatic spinal disease with epidural compression at the T8 level. Six weeks postoperatively, he was placed in hospice care. Conclusion Prior reports in the literature demonstrated a poor prognosis for Merkel cell carcinoma metastasis to the spine with survival ranging from 1 to 9 months after diagnosis. Although neurologic decline necessitates a surgical intervention, the assessment of operative benefit should take into account the prognosis associated with the primary tumor subtype.

No MeSH data available.


Related in: MedlinePlus

(A) Sagittal computed tomography scan and (B) thoracic spine radiograph demonstrating a T5 corpectomy and cage placement with T3–T7 posterior fusion.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4516752&req=5

FI1400068-2: (A) Sagittal computed tomography scan and (B) thoracic spine radiograph demonstrating a T5 corpectomy and cage placement with T3–T7 posterior fusion.

Mentions: The patient presented to the emergency room with right lower extremity weakness and difficulty with ambulation resulting in several falls over a 1- to 2-week period 16 months after initial diagnosis. He denied trauma, numbness, tingling, paresthesias, or urinary/bowel dysfunction. On neurologic exam, the patient's left lower extremity motor strength was 1 to 2/5 throughout, and the right lower extremity was 4/5, with upgoing toes and hyperreflexia. An MRI demonstrated a T5 solitary epidural mass encasing and compressing the spinal cord that extended into the paraspinal muscles bilaterally, left greater than right, focused at the T5 vertebral body and extending from the midlevel of T4 with neural foraminal invasion to the middle of the T6 vertebral body (Fig. 1). The patient underwent a T5 transpedicular approach for an intralesional resection through a corpectomy with cage placement and a T3–T7 posterior spinal fusion because the bony destruction involved the entire vertebral body and posterior neural elements encasing the spinal cord (Fig. 2). Postoperatively, the patient's motor exam improved to 3/5 in his left lower extremity (baseline from a previous stroke) and 5/5 strength in the right lower extremity, and he was able to ambulate with a walker again. Pathologic examination demonstrated a metastatic neuroendocrine tumor consistent with his prior diagnosis of MCC.


Merkel Cell Spinal Metastasis: Management in the Setting of a Poor Prognosis.

Goodwin CR, Mehta AI, Adogwa O, Sarabia-Estrada R, Sciubba DM - Global Spine J (2015)

(A) Sagittal computed tomography scan and (B) thoracic spine radiograph demonstrating a T5 corpectomy and cage placement with T3–T7 posterior fusion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4516752&req=5

FI1400068-2: (A) Sagittal computed tomography scan and (B) thoracic spine radiograph demonstrating a T5 corpectomy and cage placement with T3–T7 posterior fusion.
Mentions: The patient presented to the emergency room with right lower extremity weakness and difficulty with ambulation resulting in several falls over a 1- to 2-week period 16 months after initial diagnosis. He denied trauma, numbness, tingling, paresthesias, or urinary/bowel dysfunction. On neurologic exam, the patient's left lower extremity motor strength was 1 to 2/5 throughout, and the right lower extremity was 4/5, with upgoing toes and hyperreflexia. An MRI demonstrated a T5 solitary epidural mass encasing and compressing the spinal cord that extended into the paraspinal muscles bilaterally, left greater than right, focused at the T5 vertebral body and extending from the midlevel of T4 with neural foraminal invasion to the middle of the T6 vertebral body (Fig. 1). The patient underwent a T5 transpedicular approach for an intralesional resection through a corpectomy with cage placement and a T3–T7 posterior spinal fusion because the bony destruction involved the entire vertebral body and posterior neural elements encasing the spinal cord (Fig. 2). Postoperatively, the patient's motor exam improved to 3/5 in his left lower extremity (baseline from a previous stroke) and 5/5 strength in the right lower extremity, and he was able to ambulate with a walker again. Pathologic examination demonstrated a metastatic neuroendocrine tumor consistent with his prior diagnosis of MCC.

Bottom Line: The surgical management for MESCC depends on pathology.Three weeks postoperatively, the patient re-presented with new-onset weakness and widespread metastatic spinal disease with epidural compression at the T8 level.Six weeks postoperatively, he was placed in hospice care.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

ABSTRACT
Study Design Case report. Objective Merkel cell carcinoma is an aggressive neuroendocrine carcinoma with a poor prognosis. Metastatic epidural spinal cord compression (MESCC) is a debilitating disease causing neurologic deficits. The surgical management for MESCC depends on pathology. Methods We report a case of Merkel cell carcinoma of the spine and evaluate the treatment paradigms utilized in the prior reports. Result A 76-year-old man with a history of Merkel cell carcinoma presented with 2-week history of progressive difficulty ambulating and a solitary T5 epidural mass encasing the spinal cord. The patient underwent a T5 corpectomy with cage placement and T3 to T7 posterior fusion with postoperative neurologic improvement and a return to ambulation. Three weeks postoperatively, the patient re-presented with new-onset weakness and widespread metastatic spinal disease with epidural compression at the T8 level. Six weeks postoperatively, he was placed in hospice care. Conclusion Prior reports in the literature demonstrated a poor prognosis for Merkel cell carcinoma metastasis to the spine with survival ranging from 1 to 9 months after diagnosis. Although neurologic decline necessitates a surgical intervention, the assessment of operative benefit should take into account the prognosis associated with the primary tumor subtype.

No MeSH data available.


Related in: MedlinePlus