Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.379
Peer-review started: May 28, 2020
First decision: November 14, 2020
Revised: November 24, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021
Spinal metastases are common in patients with malignancies, but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis. Knowledge of surgical complications, particularly perioperative mortality, in patients with spinal metastases from unidentified sources is still insufficient.
A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra (T7). Radiographic examinations, as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion, resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion. Therefore, spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis. Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma. As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery, the origin of this metastasis was undetermined. We discuss this case with respect to reported perioperative mortality in similar cases.
A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.
Core Tip: Studies on spinal metastases with unknown primary tumors (UPTs) are scarce due to the difficulty in diagnosis and treatment of this disease. Perioperative death, is one of the most serious complications and plays an important role in the prognostic outcome of spinal metastasis. Studies that directly analyze perioperative mortality in patients with unidentified origins of spinal metastases are still very rare. We describe a rare case of thoracic vertebral metastasis from an UPT who died in hospital after surgery due to dramatic deterioration of the disease. This uncertain diagnosis and rapid progression represent a highly unexpected disease presentation.