A Case of Metastatic Spinal Tumor from Progressive Breast Cancer Detected as a Pathological Fracture

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  • Fujita Shusuke
    Department of Neurosurgery, Atsugi City Hospital Department of Neurosurgery, Jikei University School of Medicine
  • Tochigi Satoru
    Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital
  • Kawamura Daichi
    Department of Neurosurgery, Jikei University School of Medicine
  • Hatano Keisuke
    Department of Neurosurgery, Jikei University School of Medicine
  • Kato Naoki
    Department of Neurosurgery, Atsugi City Hospital
  • Takeishi Hideaki
    Department of Neurosurgery, Atsugi City Hospital
  • Tani Satoshi
    Department of Neurosurgery, Jikei University School of Medicine
  • Murayama Yuichi
    Department of Neurosurgery, Jikei University School of Medicine
  • Terao Tohru
    Department of Neurosurgery, Atsugi City Hospital

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Other Title
  • 軸椎の病的骨折を契機に診断された進行乳がんの1例

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Abstract

<p>  The life expectancy of patients with progressive breast cancer has recently increased, thanks to advancements in chemotherapy, hormone treatment, and molecular target drugs. As the number of advanced breast cancer survivors increase, these initial treatments are typically required prior to spinal surgery. This is because asymptomatic breast cancer may initially be diagnosed as a pathological vertebral fracture. The decision for comprehensive treatment of the malignancy later on could benefit from improved performance status by spinal surgeries.</p><p>  A 68 year-old female was admitted to our hospital because of sudden neck pain without neurological deficits. Brain magnetic resonance image (MRI) demonstrated multiple metastatic lesions in the skull. Cervical computed tomography (CT) showed a burst fracture in the C2 vertebral body, and spinal MRI showed multiple metastatic lesions in the cervical spine, including in the C2 vertebral body. Furthermore, chest CT showed a mass lesion in the right breast. With a diagnosis of pathological fracture, the primary lesion was found to be progressive breast cancer. The patient’s life expectancy was estimated at more than 6 months according to the Tokuhashi score. Her cervical spine was considered unstable based on the spine instability neoplastic score (SINS). We performed posterior cervical fixation, hormone therapy, and chemotherapy. The treatment was planned according to the results of the breast and skull biopsies. The diagnosis was progressive breast cancer (Luminal A-like), and there was no discordance between the two results. Her postoperative course was good ; however, the patient died 21 months after surgery.</p><p> Patients with pathological vertebral fracture from progressive breast cancer are often expected to live more than 6 months. Surgical treatment for vertebral fractures and subsequent treatment according to pathological findings lead to a good prognosis.</p>

Journal

  • Spinal Surgery

    Spinal Surgery 35 (2), 203-207, 2021

    The Japanese Society of Spinal Surgery

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