A Case of Eccrine Tumour Metastasis to Spine Managed with Posterior Spinal Stabilization with Recovering Paraparesis

Authors : Dr. Kingshuk Ganguly; Dr. Ashwin Shetty; Dr. Santosh Babu

Volume/Issue : Volume 8 - 2023, Issue 1 - January

Google Scholar : https://bit.ly/3IIfn9N

Scribd : https://bit.ly/3HPbJfN

DOI : https://doi.org/10.5281/zenodo.7627390

Introduction: Tumour metastasis to the spine very rarely occurs from an adnexal tumour and an accurate and fast diagnosis is essential for good patient management. Methodology: 52 year old male came with complaints of mid back pain since 2 months and weakness of bilateral lower limbs since 3 weeks a with progressive loss of bowel and bladder control since 3 days noted at presentation. Patient was previously operated for excision of a mass over left hand hypothenar region 1 year back which on histopathological evaluation had showed an eccrine tumour. XRAYs revealed a T8 compression fracture of the spine and MRI was done which revealed compression fracture of T8 vertebra with involvement of posterior elements and an anterior epidural collection causing canal stenosis and similar lesions noted in T 7 and T 9 vertebra with a suspicion of metastasis. Hence a PET scan was done and showed lytic lesions in multiple vertebral bodies ,posterior elements,left iliac and left SI joint extending to acetabulum and femoral shaft.Patient was planned for stabilisation of spine with a vertebral biopsy and patient underwent a T7 to T11 posterior spinal stabilisation with polyaxial pedicle screws and biopsy from T8 vertebra. Postoperatively, the patient was evaluated and paraparesis recovered and patient was begun on physiotherapy exercises for faster recovery. The histopathology report showed features of poorly differentiated metastatic squamous cell cancer and immunohistochemistry markers were done which was positive for CK and CK 5 / 6 which indicated a skin or adnexal tumour. Patient is recovering postoperatively with mobilisation using KT brace and on a wheel chair with recovering neurological status. Results- :An eccrine tumour with metastasis to the thoracic spine and lesions over pelvic bones was managed with spinal stabilisation using pedicle screws with biopsy from the T8 vertebra suggesting an adnexal primary lesion. Conclusion- :A rare case of an adnexal tumour metastasis to the spine can be managed effectively with posterior spinal stabilisation with partial or complete recovery of neurological status. Importance of a good history with early identification using PET scan and an immunohistochemistry to locate the primary were key turning points in management of this case

Keywords : Paraparesis, Eccrine, Tumour, Spine


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