Diagnosis and treatment of spinal myeloid sarcoma with acute spinal cord compression as an initial symptom: a report of 5 cases
Liu Yujie1, Hu Mengzi2, Liu Weibo3, Xu Kehan1, Li Bo1, Wan Wei1, Xiao Yasong1, Xiao Jianru1
1Department of Orthopedic Oncology, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China; 2Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China; 3Department of Spine Surgery, Qingdao Central Hospital, Qingdao 266042, China
Abstract:Objective To explore the clinicopathological features, imaging features and treatment of spinal cord myeloma in patients with spinal cord compression as the first symptom.Methods The retrospective cross-sectional study was conducted which the clinical data of five patients with spinal myeloid sarcoma confirmed by bone marrow aspiration and pathology from January 2014 to December 2017 in Changzheng Hospital. There were 3 males and 2 females, aged from 15 to 54 years old. the tumors were located in 3 cases of thoracic vertebrae and 2 cases of lumbar vertebrae. Four cases were treated with open surgery. After discharge, they were treated with chemotherapy and hematological tumors according to bone marrow puncture and pathological results. Another patient underwent conservative treatment (anti-inflammatory analgesia, nutritional support, chemotherapy, etc.). The observation items were analysed.Results All the 5 patients had a low back pain, three of them had a lower limbs weakness, and one of them was accompanied by paralysis of both lower limbs. X-ray examination showed no abnormal findings. CT and MRI showed bone destruction or soft tissue shadow. Bone marrow aspiration and postoperative pathological examination showed that five cases were leukemia including four acute myeloid leukemia(AML)and one chronic myeloid leukemia(CML). All patients' preoperative symptoms were relieved after treatment. All patients were followed up. One patient underwent IA regimen chemotherapy for five courses, and was treated with allogeneic hematopoietic stem cell transplantation. It had been followed up for 28 months after surgery and still in good condition without tumor recurrence. The other four patients relapsed after chemotherapy, all died of infection, and the survival period was from 5 to 26.5 months.Conclusions Spinal cord compression caused by myeloid sarcoma as an initial symptom is rare. The imaging manifestations of the myeloid sarcoma are lack of specificity and and it is easy to be misdiagnosed. Bone marrow aspiration and pathological examination can confirm the diagnosis. When the symptoms of spinal cord compression occur, it is recommended to perform early tumor decompression. The allogeneic hematopoietic stem cell transplantation and systemic chemotherapy should be performed after surgery.
刘玉杰, 胡孟子, 刘伟波, 许克寒, 李博, 肖雅松, 万维, 肖建如. 以脊髓压迫为首发症状的髓系肉瘤5例临床分析[J]. 中华解剖与临床杂志, 2019, 24(3): 215-220.
Liu Yujie, Hu Mengzi, Liu Weibo, Xu Kehan, Li Bo, Wan Wei, Xiao Yasong, Xiao Jianru. Diagnosis and treatment of spinal myeloid sarcoma with acute spinal cord compression as an initial symptom: a report of 5 cases. Chinese Journal of Anatomy and Clinics, 2019, 24(3): 215-220.
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