Metastatic Disease of Spine - Pathology

(OBQ09.83) You are caring for a 63-year-old female with metastatic breast cancer to the lumbar spine. Her neurological examination shows significant weakness in leg function and she is having difficulty ambulating. Imaging shows significant neural element compression by the tumor and complete erosion of the L1 vertebrae. She has no other sites of metastatic disease and is otherwise healthy. What treatment option do you recommend to best maintain her function? Review Topic

QID: 2896

1

Palliative therapy

1%

(29/2592)

2

Complete neural element decompression

0%

(11/2592)

3

Complete neural element decompression with instrumentation to stabilize the spine

9%

(226/2592)

4

Complete neural element decompression, instrumentation, and postoperative chemotherapy

24%

(628/2592)

5

Complete neural element decompression, instrumentation, and postoperative radiotherapy

65%

(1692/2592)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ08.66) A 47-year-old female, otherwise in good general condition, has intractable back pain from metastatic breast cancer isolated to her spine. She has failed progressive multi-agent chemotherapy and hormone therapy. Her exam is normal except for slight sensory dysesthesia, hyperreflexic patellar tendons, and mild gait instability which she reports has been worsening. Cervical, thoracic, and lumbar MRI show an isolated metastatic lesion involving the T9 vertebral body with moderate cord compression of the ventral spinal cord. At this stage what is the best treatment? Review Topic

QID: 452

1

Change chemotherapy protocol to Cyclophosphamide, Hydroxydanurubicin, Oncovin, Prednisone

1%

(9/1209)

2

Posterior spinal decompression after vertebral body kyphoplasty

5%

(60/1209)

3

Thoracic corpectomy, instrumented spinal fusion, and postoperative radiotherapy

82%

(997/1209)

4

Radiation therapy

11%

(130/1209)

5

Palliative care unit

1%

(9/1209)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ12.162) A 62-year-old male patient presents with severe lower back pain radiating to his right lower abdomen and right leg. He previously underwent a right nephrectomy for renal cell carcinoma. On physical exam, he has weakness with right knee extension which is affecting his ability to ambulate. An MRI is performed and is shown in Figures A and B. Staging studies determine this to be an isolated metastatic lesion. What is the next best step in this patient's treatment? Review Topic

QID: 4522

FIGURES:

A
B

1

Chemotherapy alone

1%

(29/4368)

2

Radiation alone

3%

(118/4368)

3

Vertebroplasty

1%

(33/4368)

4

Embolization, surgical decompression and stabilization followed by radiation

88%

(3834/4368)

5

Surgical decompression and stabilization followed by radiation

8%

(332/4368)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ12.124) A 68-year-old male presents to the emergency room with neck pain and progressive weakness to the point that he is unable to walk. Prior to this event he was in good health and active. On physical exam he is an ASIA C. Radiographs, computed tomography, and an MRI are show in Figure A,B, and C respectively. A CT of the chest, abdomen, and pelvis shows a single resectable lesion in the rectum consistent with a primary malignancy. Sagittal images of the spine show a single metastatic lesion in the thoracic spine, but no signs of thoracic canal compromise. He has no other metastatic bone lesions. What is the best treatment for this patient? Review Topic

QID: 4484

FIGURES:

A
B
C

1

Surgical decompression and stabilization followed by radiation

75%

(2735/3659)

2

Radiation followed by surgical decompression and fusion

15%

(541/3659)

3

Radiation alone

5%

(185/3659)

4

Chemotherapy alone

1%

(35/3659)

5

Palliative measures

4%

(133/3659)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(OBQ08.204) A 67-year-old retired male custodian complains of progressively worsening low back pain over the past 6 months. He has not seen a doctor in the past 15 years. He admits to a 40 pack year smoking history, fatigue, and an unintentional 15 pound weight loss over the past year. A radiograph of the pelvis is provided in Figure A. Which of the following would most likely confirm the diagnosis? Review Topic

QID: 590

FIGURES:

A

1

Urine immunoelectrophoresis (UPEP)

12%

(140/1130)

2

Thyroid biopsy

1%

(8/1130)

3

CBC and blood smear

3%

(32/1130)

4

Prostate biopsy

81%

(915/1130)

5

Renal ultrasound

3%

(29/1130)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ05.207) A 59-year-old female presents with a metastatic spinal tumor and has a lytic lesion in the T12 vertebral body. The process of bone resorption in her lytic lesion is mediated by Review Topic

QID: 1093

1

Direct resorption of bone by tumor cells

2%

(12/580)

2

Neoangiogenesis of the vertebral body

2%

(9/580)

3

Macrophage-mediated bony destruction

7%

(38/580)

4

Tumor induced activation of osteoclasts

88%

(512/580)

5

Necrosis of the vertebral body

1%

(5/580)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ09.51) A 59-year-old female with a history of biopsy proven metastatic renal cell carcinoma presents with a thoracic spine lesion consistent with renal cell carcinoma. She has lower extremity weakness and sustained clonus bilaterally. What is the most appropriate management prior to surgery? Review Topic

QID: 2864

1

Blood cultures

0%

(8/2006)

2

High dose IV methylprednisone

2%

(50/2006)

3

Arterial embolization

90%