Fibroma condromixóide da coluna torácica: Relato de caso e revisão da literatura

Leal Filho, Manoel Baldoino; Pereira Neto, Aldo; Pereira, Luís Cláudio Modesto; Franco, Paulo Saide; Suzuki, Kunio; De Mello, Paulo Andrade; Burnett, José Cláudio B.; Veloso, Moema Gonçalves P.

doi:10.1590/S0004-282X1995000500024

Resumos

Os autores relatam caso de compressão medular torácica por lesão da quinta articulação costovertebral à direita. O diagnóstico pré-operatório, com mielotomografia, foi de processo expansivo intrarraquidiano extradural ao nível de T5. Feita a abordagem cirúrgica por laminectomia, com ressecção apenas da lesão intrarraquidiana. O diagnóstico de fibroma condromixóide somente foi definido com o estudo histopatológico. A paciente teve importante melhora neurológica. Decidiu-se pelo acompanhamento clínico e radiológico. Após dois anos houve recidiva do processo para dentro do canal raquidiano. Desta vez, foi realizada abordagem posterolateral à direita, por costotransversectomia e retirada da lesão. O diagnóstico histopatológico foi o mesmo. A paciente evoluiu com melhora neurológica e está sendo feito o seguimento há dois anos. Chamamos a atenção para a raridade do caso e discutimos a conduta.

fibroma condromixóide; tumor intrarraquidiano; laminectomia; costotransversectomia

A case of chondromyxoid fibroma (CMF) arising from the Sth right costovertebral junction and spreading into spinal canal causing spinal cord compression is presented. A myelotomography revealed a complete block at T5 level. The patient underwent a decompressive laminectomy with removal of an epidural tumor. This specimen was sent for pathological examination and interpreted as a CMF. The patient had a neurological improvement, post operative MRI revealed a spinal cord free of compression, and we decided on the follow up of the case. Two years later there was reccurrence of the tumor. A posterolateral access by costotransversectomy was made and the lesion was resected. The patient had a neurological improvement which persists on the follow up (two years, at present). Clinical, radiologic and histologic findings, surgical management and recurrence are discussed. The pertinent literature is reviewed.

chondromyxoid fibroma; spinal cord compression; laminectomy; costotransversectomy

Fibroma condromixóide da coluna torácica. Relato de caso e revisão da literatura

Chondromyxoid fibroma compressing the spinal cord: case report and review of the literature

Manoel Baldoino Leal Filho^I; Aldo Pereira Neto^I; Luís Cláudio Modesto Pereira^I; Paulo Saide Franco^I; Kunio Suzuki^I; Paulo Andrade De Mello^I; José Cláudio B. Burnett^II; Moema Gonçalves P. Veloso^III

^INeurocirurgião. Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF)

^IINeuroradiologista;Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF)

^IIIPatologista. Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF)

RESUMO

Os autores relatam caso de compressão medular torácica por lesão da quinta articulação costovertebral à direita. O diagnóstico pré-operatório, com mielotomografia, foi de processo expansivo intrarraquidiano extradural ao nível de T5. Feita a abordagem cirúrgica por laminectomia, com ressecção apenas da lesão intrarraquidiana. O diagnóstico de fibroma condromixóide somente foi definido com o estudo histopatológico. A paciente teve importante melhora neurológica. Decidiu-se pelo acompanhamento clínico e radiológico. Após dois anos houve recidiva do processo para dentro do canal raquidiano. Desta vez, foi realizada abordagem posterolateral à direita, por costotransversectomia e retirada da lesão. O diagnóstico histopatológico foi o mesmo. A paciente evoluiu com melhora neurológica e está sendo feito o seguimento há dois anos. Chamamos a atenção para a raridade do caso e discutimos a conduta.

Palavras-chave:fibroma condromixóide, tumor intrarraquidiano, laminectomia, costotransversectomia.

SUMMARY

A case of chondromyxoid fibroma (CMF) arising from the Sth right costovertebral junction and spreading into spinal canal causing spinal cord compression is presented. A myelotomography revealed a complete block at T5 level. The patient underwent a decompressive laminectomy with removal of an epidural tumor. This specimen was sent for pathological examination and interpreted as a CMF. The patient had a neurological improvement, post operative MRI revealed a spinal cord free of compression, and we decided on the follow up of the case. Two years later there was reccurrence of the tumor. A posterolateral access by costotransversectomy was made and the lesion was resected. The patient had a neurological improvement which persists on the follow up (two years, at present). Clinical, radiologic and histologic findings, surgical management and recurrence are discussed. The pertinent literature is reviewed.

Key words:chondromyxoid fibroma, spinal cord compression, laminectomy, costotransversectomy.

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Aceite: 7-agosto-1995.

Dr. Manoel Baldoino Leal Filho - Rua 7 de Setembro 526/Sul - 64001-210 Teresina PI - Brasil

1. Benson WR, Bass S. Chondromyxoid fibroma: first report of occurrence of this tumor in vertebral column. Am J Clin Path 1955, 25:1290-1292.
2. Feldman F, Hecht HL, Jonhston AD. Chondromyxoid fibroma of bone. Radiology 1970, 94:249-260.
3. Jaffe HL, Lichtenstein L. Chondromyxoid fibroma of bone: a distinctive benign tumor likely to be mistaken especially for chondrosarcoma. Arch Pathol 1948, 45:541-551.
4. Mirra JM. Intramedulary cartilage and chondroid producing tumors. In Bone tumors: clinical, radiologic and pathologic correlations. Philadelphia: Lea and Febiger, 1989, p 623-648.
5. Nunez C, Bennett T, Bohlman HH. Chondromyxoid fibroma of the toracic spine: case report and review of the literature. Spine 1982, 7:436-439.
6. Rahimi A, Beabout JW, Ivins JC, Dahlin DC. Chondromyxoid fibroma: a clinicopathologic study of 76 cases. Cancer 1972, 30:726-736.
7. Ramani PS. Chondromyxoid fibroma: a rare cause of spinal cord compression. Case report. J Neurosurg 1974, 40:107-109.
8. Rivierez M, Richard S, Pradat P, Devred C. Fibrome chondro-myxoïde du rachis cervical: à propos d'un cas traité par vertébrectomie partielle. Neurochirurgie 1991, 37:264-268.
9. Schajowicz F, Gallardo H. Chondromyxoid fibroma (fibromyxoid chondroma) of bone: a clinicopathologic study of 32 cases. J Bone Joint Surg 1981, 53B :198-216.
10. Sim FH, Frassica FJ, Wold LE, McLeod RA. Chondrosarcoma of the spine: Mayo Clinic experience. In Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI (eds). Tumors of the spine: diagnosis and clinical management. Philadelphia: Saunders, 1990, pl59.
11. Standefer M, Hardy RWJr, Marks K, Cosgrove MD. Chondromyxoid fibroma of the cervical spine: a case report with a review of the literature and a description of an operative approach to the lower anterior cervical spine. Neurosurgery 1982, 11:288-292.
12. Zilmer DA, Dorfman HD. Chondromyxoid fibroma of bone: thirty six cases. Clinicopathologic correlation. Human Pathol 1989, 20:952-964.

Datas de Publicação

Publicação nesta coleção
08 Dez 2010
Data do Fascículo
Dez 1995

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[1] 1. Benson WR, Bass S. Chondromyxoid fibroma: first report of occurrence of this tumor in vertebral column. Am J Clin Path 1955, 25:1290-1292.

[2] 2. Feldman F, Hecht HL, Jonhston AD. Chondromyxoid fibroma of bone. Radiology 1970, 94:249-260.

[3] 3. Jaffe HL, Lichtenstein L. Chondromyxoid fibroma of bone: a distinctive benign tumor likely to be mistaken especially for chondrosarcoma. Arch Pathol 1948, 45:541-551.

[4] 4. Mirra JM. Intramedulary cartilage and chondroid producing tumors. In Bone tumors: clinical, radiologic and pathologic correlations. Philadelphia: Lea and Febiger, 1989, p 623-648.

[5] 5. Nunez C, Bennett T, Bohlman HH. Chondromyxoid fibroma of the toracic spine: case report and review of the literature. Spine 1982, 7:436-439.

[6] 6. Rahimi A, Beabout JW, Ivins JC, Dahlin DC. Chondromyxoid fibroma: a clinicopathologic study of 76 cases. Cancer 1972, 30:726-736.

[7] 7. Ramani PS. Chondromyxoid fibroma: a rare cause of spinal cord compression. Case report. J Neurosurg 1974, 40:107-109.

[8] 8. Rivierez M, Richard S, Pradat P, Devred C. Fibrome chondro-myxoïde du rachis cervical: à propos d'un cas traité par vertébrectomie partielle. Neurochirurgie 1991, 37:264-268.

[9] 9. Schajowicz F, Gallardo H. Chondromyxoid fibroma (fibromyxoid chondroma) of bone: a clinicopathologic study of 32 cases. J Bone Joint Surg 1981, 53B :198-216.

[10] 10. Sim FH, Frassica FJ, Wold LE, McLeod RA. Chondrosarcoma of the spine: Mayo Clinic experience. In Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI (eds). Tumors of the spine: diagnosis and clinical management. Philadelphia: Saunders, 1990, pl59.

[11] 11. Standefer M, Hardy RWJr, Marks K, Cosgrove MD. Chondromyxoid fibroma of the cervical spine: a case report with a review of the literature and a description of an operative approach to the lower anterior cervical spine. Neurosurgery 1982, 11:288-292.

[12] 12. Zilmer DA, Dorfman HD. Chondromyxoid fibroma of bone: thirty six cases. Clinicopathologic correlation. Human Pathol 1989, 20:952-964.