Hospital Based Seminar—Oncology

Hospital XXXXXXX, City-Country

Case presenter XXXXXXX
Author: Matías Petracchi (AR)

Clinical Case 01
Clinical Information
Female, 32 years old
Reason for consultation:
• 6 months of thoracic back pain.
Physical examination:
• No deficits on neurological examination
Backgrounds:
• 2 years ago, breast cancer. Surgery Quadrantectomy left breast, chemotherapy, and local radiotherapy.
• 6 moths ago started with back pain associated with a solitary lesion in T8, was biopsied with a negative
result
Laboratories:
• Normal

2
Complementary studies

3
Complementary studies

4
Complementary studies
Needle Biopsy in other center: no malignancy

5
Complementary studies
5 months later

6
Complementary studies
5 months later

7
Complementary studies
5 months later

8
Complementary studies

9
First study 5 months later
Summary
Female, 32 years old
Backgrounds:
• 2 years ago, breast cancer. Surgery Quadrantectomy
left breast, chemotherapy, and local radiotherapy.
• 6 moths ago, started with back pain associated with a
solitary lesion in T8, was biopsied with a negative
result
Physical examination:
• No deficits on neurological examination
Laboratories:
• Normal

Discussion topics:
1. Classification
2. Need for complementary studies?
3. Treatment options
10
Summary
Female, 32 years old
Backgrounds:
• 2 years ago, breast cancer. Surgery Quadrantectomy
left breast, chemotherapy, and local radiotherapy.
• 6 moths ago, started with back pain associated with a
solitary lesion in T8, was biopsied with a negative
result
Physical examination:
• No deficits on neurological examination
Laboratories:
• Normal

Discussion topics:
1. Classification
2. Need for complementary studies?
3. Treatment options
12
Complementary studies
• Thorax, abdominal and pelvic scans: no
lesions

• Lab: normal

13
Complementary studies

14
Complementary studies
New needle biopsy: Carcinoma

15
Pre-reading material

16 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
Pre-reading material

17 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
Pre-reading material

18 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
Pre-reading material

19 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
¿Surgery? SINS score

20
Pre-reading material

21 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
Treatment
Prognosis and type of
treatment: Tokuhashi score

22
Surgical approaches by region

24 https://aosla.com.br/edudatabase/home?format=Publication&pathology=Tumor&type=AO%20Spine%20Masters%20Series
Treatment

y
o m
l oc ect
B br
n
e rte
ve

25
Summary
Female, 32 years old
Backgrounds:
• 2 years ago, breast cancer. Surgery Quadrantectomy
left breast, chemotherapy, and local radiotherapy.
• 6 moths ago, started with back pain associated with a
solitary lesion in T8, was biopsied with a negative
result
Physical examination:
• No deficits on neurological examination
Laboratories:
• Normal

Discussion topics:
1. Classification
2. Need for complementary studies?
3. Treatment options
27
Treatment
Surgery? SINS score

1+3+2+2+2+1=11: surgical consultation

28
Treatment
Prognosis and type of
treatment: Tokuhashi score
Tokuhashi:
Excisional Surgery

Total: 2 + 2 + 2 + 2 + 5 + 2 = 15

29
Treatment
PLAN: Vertebrectomy en bloc excision by posterior approach

31
Treatment
Spinal angiography and preoperative embolization of T8.
Adamkiewics origins in left L1

32
Treatment
Vertebrectomy en bloc excision by
1 stage:
- Pedicle Instrumentation
- Laminectomy
- Bilateral partial costal resection T7,8,9,
- Bilateral Root section
- Detatchment of the retropleura to
expose de vertebral body
- Segmental vessel ligation and Distal Proximal
separation of the great vessels
- Transversal osteotomy of the inferior
plate of T7 and superior plate of T9 with
gigli saw
- Ends the osteotomies with osteotome
- Reconstruction and arthrodesis with
Harms cage and bone
- Second rod
33
Treatment
Reconstruction an second rod

Distal Proximal

34
Treatment
Vertebrectomy en bloc excision by
1 stage:

- Pedicle Instrumentation
- Laminectomy
- Bilateral partial costal resection
T7,8,9,
- Bilateral Root section
- Detatchment of the retropleura
to expose de vertebral body
- Segmental vessel ligation and
separation of the great vessels
- Transversal osteotomy of the
inferior plate of T7 and superior
plate of T9 with gigli saw
- Ends the osteotomies with
osteotome.
- Reconstruction and arthrodesis
with Harms cage and bone.
- Second rod.
35
Treatment

CT control
36
Treatment
Treatment
Pathology: confirms adenocarcinoma with RE- RP+

38
Treatment

39
Treatment
1 year later:
- Liver mets
- No local recidiva

- Endocrine and Qxt treatment

40
Take home message Stabilize pathological
instability
Determine likely prognosis
Restore balance in
pathological deformity

Preserve quality of life

and collaborate with
oncology colleagues

• Understand the disease and treatment possibilities.

• Discuss it with oncologist.
• Surgery? SINS score
• Evaluate surgical alternatives​, Tokuhashi and Tomita scores

41