Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 379-388
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.379
Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature
Xiu-Mao Li, Li-Bin Jin
Xiu-Mao Li, Li-Bin Jin, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Author contributions: Li XM and Jin LB conceived the report; Jin LB analyzed and interpreted the patient data regarding the disease; Li XM reviewed the literature, and contributed to acquisition of data and manuscript drafting; both authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81702662.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiu-Mao Li, MD, PhD, Surgeon, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China.
Received: May 28, 2020
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.

Keywords: Hospital mortality, Spine, Neoplasm metastasis, Unknown primary, Carcinoma, Case report

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.