Article
Figure 2. A well delimited lytic lesion on the left side of T11 body was observed on CT scan. This lesion conditioned a nar- rowing of the vertebral canal, with slight compression of the spinal cord. Arrow in- dicating the lesion.
describe, are more likely to develop extra- adrenal
and malignant disease10
lesions [abdominal or .
thoracic]
The WHO defines malignant pheochro- mocytomas and paragangliomas as meta- static disease at sites where chromaffin tissues are not usually present. Metastatic sites include the lungs, bones, liver, and lymph nodes. Malignant tumours are typi- cally larger, have a higher mitotic count, have extensive local or vascular invasion and express fewer peptides on immunohis- tochemical studies compared with benign tumours11
.
There is little correlation between his- tologic appearance and malignant poten- cial. Tumours with significant atypia and pleomorphism have often behaved in be- nign fashion, possibly because they were removed
before metastasis.
whereas SDHB mutations [PGL type 4] are associated with extra-adrenal disease and malignancy8,9
.
Several studies have suggested that pa- tients who are carriers of the SDHB mu- tation [PGL type 4], like the patient we
Benign-ap-
pearing tumours can behave in aggressive fashion. Several authors have found that the presence of mitosis in the pathologic specimen correlated significantly with ma- lignancy12
. In these series, mitotic figures were seen in all malignant tumours. Paragangliomas often exhibit a pro- longed time interval to the development of
recurrence or metastasis. Recurrence and/ or distant metastases have been reported to occur from 0 to 20 years after diagnosis3,12
.
In the current case the patient presented one local recidiva and a distant metasta- sis 9 and 10 years after the initial diagno- sis, respectively. In both situations it was decided that the patient was eligible for surgical treatment with curative intention because these were always isolated lesions at the time of diagnosis13
.
The patient underwent a biannual moni- toring program with physical examina- tion and measurement of blood pressure and levels of urinary catecholamines and metanephrines14
. The fact that the patient
presented only a solitary metastasis was the reason the authors chose to pursuit a surgical exertion, in an attempt to perform a curative treatment. It was taken under consideration the fact that metastatic para- ganglioma, like pheochromocytoma, is relatively radioresistant, as compared with lymphoma and breast cancer13
.
The reason to choose a surgical inter- vention instead of chemotherapy in the T11 lesion was also based in the risk of vertebral colapse with the consequent dan-
Figure 3. On MRI this expansive lesion with low signal in T1 WI and high signal in T2 WI conditioned left root compression and enhanced after gadolinium injection. These features suggest the diagnosis of a malignant lesion, most probably a metastasis. Ar- row indicating the lesion.
22 | SpinalSurgeryNews | Autumn 2012
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