Total En Bloc Spondylectomy of L3 Vertebra for Histiocytic Sarcoma

Full article available online at Healio.com/Orthopedics. Search: 20120327-38 This article describes a rare malignant spinal tumor successfully treated with total en bloc spondylectomy via a posterior approach. The purpose of this study was to emphasize the occurrence of primary histiocytic sarcoma in the lumbar spine. Histiocytic sarcomas are rare, malignant neoplasms of the lymphohematopoietic system that usually occur in the skin, lymph nodes, and intestinal tracts. Primary spinal column histiocytic sarcoma is rare. To the authors’ knowledge, no reports have been published of treating this tumor with total en bloc spondylectomy. A 27-year-old woman presented with a 2-month history of intermittent low back pain and right lower extremity pain. Magnetic resonance imaging and computed tomography (CT) revealed a lumbar vertebra tumor. Positron emission tomography/CT showed focal accumulation in the tumor site. The patient was diagnosed with a histiocytic sarcoma based on biopsy findings and underwent total en bloc spondylectomy of L3 and reconstruction via a posterior approach. The patient maintained normal neurologic function, and the pain was lessened. No major complications occurred. No radiotherapy or chemotherapy was administered postoperatively, and no local tumor recurrence or distant metastases existed at 2-year follow-up. The diagnosis of histiocytic sarcoma relies predominantly on the verification of histiocytic lineage and the exclusion of other, poorly differentiated, large-cell malignancies by immunohistochemical stain. Total en bloc spondylectomy at L3 via a posterior approach can be performed safely and is an important approach in the treatment of selected spinal tumors. Drs Lin, Chen, Wang, Guo, Liu, and Zeng are from the Department of Orthopaedics, 175th Hospital of PLA, Fujian, China. Drs Lin, Chen, Wang, Guo, Liu, and Zeng have no relevant financial relationships to disclose. Correspondence should be addressed to: Bin Lin, MD, Department of Orthopaedics, 175th Hospital of PLA, Zhanghua Rd 269, Zhangzhou 363000, Fujian, China (lbin175@tom.com). doi: 10.3928/01477447-20120327-38 Total En Bloc Spondylectomy of L3 Vertebra for Histiocytic Sarcoma Bin Lin, MD; Zhi-wen Chen, MD; ning wang, MD; Zhi-Min guo, MD; hui Liu, MD; Ming Zeng, MD e610 Figure: Photographs of the gross view of the anterior (A) and posterior (B) elements of the L3 vertebrae after total en bloc spondylectomy. A