Multiple spinal metastases from a well-differentiated liposarcoma of the iliac wing: a case report

Abstract

Study design: A case report.

Objectives: To report an unusual case of multiple spinal metastases from an undiagnosed well-differentiated liposarcoma (WDLPS) of the iliac wing and to stress the need of a meticulous clinical examination and further screening of patients with chronic and asymptomatic bony lesions.

Setting: University of medicine of Monastir, Department of neurological surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia and University of Medicine of Tunis EL Manar, Department of neurological surgery, Tunisian National Institute of Neurology, Tunis, Tunisia.

Methods: A 39-year-old man presented with signs of spinal cord compression for the past 2 weeks. His medical history was consistent for an asymptomatic right iliac wing mass that appeared 3 years ago and for which he has not consulted. Magnetic resonance imaging revealed multiple bony lesions of the thoraco-lumbar spine associated with a 6-cm right paravertebral mass at the T4 level extending posteriorly through the intervertebral foramina to the spinal canal causing major spinal cord compression. An emergent T2-T6 laminectomy allowed for a complete resection of the epidural mass. Pathological examination confirmed the diagnosis of well-differentiated liposarcoma. Adjunctive radiation therapy was administered.

Results: The patient's neurological status improved remarkably under an intensive care and rehabilitation program. He was ambulatory without assistance in the second postoperative week.

Conclusion: The case reported in this paper represents a genuine example of the possible metastatic potential of WDLPSs of the bone and underscores the importance of examining patients thoroughly, especially when they have chronic and asymptomatic lesions.

Figure 1

Sagittal T1-weigted post-gadolinium MR image showing multiple vertebral lesions of the thoraco-lumbar spine.

Figure 2

T2-weighted (a) and T1-weighted post-gadolinium MR images (b, c) of the cervicothoracic spine showing the transforaminal extension of the pre-vertebral mass leading to a major spinal cord compression.

Figure 3

Photomicrograph of the tumor specimen showing typical features of well-differentiated liposarcoma with variably sized adipocytes and fibromyxoid stroma containing spindle cells with large, deep-staining nuclei.