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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2024, Number 2

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Cir Columna 2024; 2 (2)

Primary spinal mesenchymal chondrosarcoma. Case report and literature review

Villanueva MJU, Luna ÁG, Gijón MR, Castillo RC, Navarro AR

Language: Spanish
References: 20
Page: 112-119
PDF size: 583.70 Kb.


ABSTRACT

Introduction: mesenchymal chondrosarcoma (MSC) is a rare and aggressive subtype that represents only between 1 to 10% of primary chondrosarcomas, the majority of these tumors are believed to originate in the bone, 50% of reported cases have a extraosseous origin, including the brain and meninges. It is extremely rare to find MCS as a primary lesion of the bony elements of the spine; the thoracic vertebrae are most often affected. Histologically, it is believed to derive from cartilage-forming primitive mesenchymal tissue and is characterized by the presence of solid, highly cellular areas composed of round or slightly fusiform primitive mesenchymal cells with foci of cartilaginous differentiation. Spinal MCS can present with a wide variety of symptoms, including sensorimotor deficits, back pain, and radiculopathy. MRI is the preferred imaging modality for intraspinal tumors, but there is no pathognomonic description for MCS. The common differential diagnosis of intraspinal and extramedullary spinal masses with variable enhancement on magnetic resonance imaging (MRI) includes meningioma, nerve sheath tumor, and myxopapillary ependymoma, but MCS should also be considered. Radical surgery with complete tumor removal is considered the best therapy option for intraspinal MCS, obtaining wide surgical margins to achieve local eradication. Local radiotherapy and postoperative systemic chemotherapy can reduce local recurrence rates, and may reduce the risk of metastasis. The course of MCS can be prolonged, with a tendency toward late local recurrence and metastasis. Case presentation: we describe the case of a 12-year-old patient who presents spinal cord compression and paraplegia attributed to T9-T11 mesenchymal chondrosarcoma. The patient was treated with aggressive local resection based on laminectomies of T9, T10 and T11, T10 corpectomy and transpedicular instrumentation T7-T8, T8-T9, T9-T11, T11-T12 and adjuvant therapy. This case and the current literature are appropriately reviewed here. Conclusion: spinal mesenchymal chondrosarcomas require early diagnosis, wide and aggressive surgical resection, radiotherapy and adjuvant chemotherapy to achieve the best results.


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