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. 2023 Jan 26:13:1110045.
doi: 10.3389/fonc.2023.1110045. eCollection 2023.

Surgical management and outcomes of spinal metastasis of malignant adrenal tumor: A retrospective study of six cases and literature review

Xiangzhi Ni  1 , Jing Wang  1 , Jiashi Cao  2 , Kun Zhang  1 , Shuming Hou  1 , Xing Huang  1 , Yuanjin Song  3 , Xin Gao  1 , Jianru Xiao  1 , Tielong Liu  1
Affiliations

Surgical management and outcomes of spinal metastasis of malignant adrenal tumor: A retrospective study of six cases and literature review

Xiangzhi Ni et al. Front Oncol. .

Abstract

Purpose: Spinal metastasis of malignant adrenal tumor (SMMAT) is an extremely rare and poorly understood malignant tumor originating from the adrenal gland. The objective of this study is to elucidate the clinical characteristics and discuss surgical management and outcomes of SMMAT.

Methods: Included in this study were six SMMAT patients who received surgical treatment in our center between February 2013 and May 2022. Their clinical data and outcomes were retrospectively analyzed to gain a better understanding of SMMAT. In addition, ten cases from the literature focusing on SMMAT were also reviewed.

Results: Surgery was performed successfully, and the associated symptoms were relieved significantly in all patients postoperatively. The mean follow-up duration was 26.2 (range 3-55) months. Two patients died of tumor recurrence 12 and 48 months after operation respectively. The other four patients were alive at the last follow-up.

Conclusions: The prognosis of SMMAT is usually poor. Preoperative embolization and early surgical radical resection can offer satisfactory clinical outcomes. The patient's health status, preoperative neurological function, tumor location and the resection mode are potential prognostic factors of SMMAT.

Keywords: adjuvant therapy; adrenal tumor; adrenocortical carcinoma; malignant phaeochromocytoma; spinal metastasis; surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A–C) Preoperative sagittal, coronal, and transverse MRI images of S1-2 vertebral body tumors; (D–F) Preoperative transverse and sagittal 3D CT images of S1-2 vertebral body tumors; (G, H) He had a history of adrenal tumor (4 points). Visceral metastases were not detectable (0 point). Bone metastases were isolated (1 point). His total prognostic score was 5 points. So, we chose the surgical strategy of total piecemeal resection. The tumor was excised by total piecemeal resection, pedicle screws, iliac screws and titanium rods were used to reconstruct the stability; (I) Hematoxylin-eosin (H&E) staining of pheochromocytoma; (J) Immunohistochemical staining for NSE; (K, L) Postoperative X-ray; (M–O) Postoperative sagittal, transverse, and coronal MRI.
Figure 2
Figure 2
Survival curve for all 6 patients. The median survival of the six patients was 48 months.
Figure 3
Figure 3
(A–C) Preoperative sagittal, coronal, and transverse MRI images of L1 vertebral body tumors; (D, E) Preoperative transverse CT scan showed L1 vertebral body tumors; (F) H&E staining of adrenocortical carcinoma; (G–I) Immunohistochemical stainings for Inhibin a, SF-1 and Syn; (J) She had a history of adrenal tumor (4 points). Visceral metastases were not detectable (0 point). Bone metastases were isolated (1 point). Her total prognostic score was 5 points. So, we chose the surgical strategy of total piecemeal resection. The tumor was excised by total piecemeal resection, pedicle screws, titanium mesh and titanium rods were used to reconstruct the stability; (K, L) Postoperative X-ray; (M–O) Postoperative sagittal, transverse, and coronal MRI.
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