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Metastatic cardiac angiosarcoma of the cervical spine. Case report
S Shapiro1, J Scott, K Kaufman
1Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, USA. sshapiro@iupui.edu
Insights
Metastatic cardiac angiosarcoma rarely affects the spine. This case report details successful surgical management of a cervical spine metastasis after preoperative embolization due to its arteriovenous malformation-like vascularity.
Area of Science:
- Oncology
- Neurosurgery
- Interventional Radiology
Background:
- Primary cardiac angiosarcoma is exceptionally rare, with limited literature.
- Spinal involvement by cardiac angiosarcoma has not been previously reported in the spine literature.
Observation:
- A patient presented with neck and arm pain, weakness, and a C5 vertebral body tumor with spinal cord compression.
- Initial surgical attempt was aborted due to extreme vascularity of the tumor.
Findings:
- The cervical spine metastasis was successfully embolized by interventional neuroradiology.
- Subsequent anterior cervical corpectomy and stabilization led to significant symptom improvement.
Implications:
- This rare spinal tumor exhibits arteriovenous malformation-like characteristics.
- Preoperative angiography and embolization are crucial for managing these highly vascular spinal tumors.
- Highlights the importance of multidisciplinary management for rare metastatic tumors.
Study Design:
A case report of metastatic cardiac angiosarcoma of the cervical spine.
Objectives:
To show that this rare spine tumor behaves in the same manner as an arteriovenous malformation and embolization, which can allow for successful spine surgery, and to discuss the natural history and rarity of this tumor.
Summary Of Background Data:
Primary angiosarcoma of the heart is a very rare tumor, with fewer than 200 reports in the English literature and nothing reported in the spine literature.
Results:
The patient in this study initially sought treatment for neck pain, left arm pain, and weakness 17 months after cardiac surgery and subsequent chemotherapy. A cervical computed tomography scan demonstrated a C5 lytic vertebral body tumor with intracannilicular extension and cord compression. An anterior cervical approach was made, but the tumor was too vascular to resect, and surgery was aborted. The C5 vascular vertebral body metastasis subsequently was embolized successfully by an interventional neuroradiologist. Reoperation via an anterior approach with corpectomy, cadaveric fibula, and anterior locking plate internal fixation was successful, producing marked improvement in the patients' symptoms.
Conclusion:
Spinal involvement by primary cardiac angiosarcoma is very rare, and this is only the second operative case ever reported. The vascular nature of this tumor makes it behave in a manner similar to that of a high-flow arteriovenous malformation. Surgery should not be undertaken before preoperative angiography and embolization. The dismal prognosis for this rare malignancy is discussed.