Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
March 2020
Next Case of the Month Coming April 7...
Left Renal Tumor with Infiltration of the Renal Vein and Inferior Vena Cava and Extension to the Spinal Column
- Background:
- Renal tumors are a common cause of bone metastasis, and the spine is the most common location for metastatic disease to bone.
- Clinical Presentation:
- Patients usually present with back pain, and with neurologic deficits if there is compression of the spinal cord or nerve roots.
- Key Diagnostic Features:
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Radiologic exams such as CT, MRI, or PET are performed to detect vertebral metastases. Metastases might have different appearances in radiologic examinations. The mineralization of the metastasis and the bone quality might influence the appearance.
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MRI has a high accuracy in detecting metastases. Usually T1-weighted MRI and fat-suppressed T2-weighted MRI are used.
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Fractures or narrowing of the spinal canal can occur.
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- Treatment:
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Radiotherapy is frequently used palliatively. Bisphosphonates such as zoledronic acid can be used alone or as a radiosensitizer. Other novel chemotherapeutic and immunotherapy agents are being developed.
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Goals of any surgical treatment are to reduce pain and stabilize the vertebral column. Preoperative embolization might be necessary, which is safe and can reduce blood loss.
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