RESUMO
OBJECTIVE: We report a patient with a cervicothoracic spinal and a mandibular adamantinoma. Adamantinoma is a rare malignant neoplasm of bone and, to our knowledge, there have been only five cases of spinal adamantinoma reported. The pathogenesis of the adamantinoma, as well as the management of this extremely rare spinal tumor, is reviewed. CLINICAL PRESENTATION: A 55-year-old man was admitted to our service with cervical pain and signs of C8 and T1 radiculopathy. On physical examination, cervical spine deformity, swelling in the left mandible region, and signs of C8 and T1 radiculopathy were observed. Neuroradiology examinations showed an osteolytic mass of the C6, C7, and T1 vertebral bodies, extending into the lateral masses and transverse processes. After surgical procedures, the patient had clinical improvement. INTERVENTION: Corpectomy of C6, C7, and T1 was performed through a cervicothoracic anterior approach. Anterior stabilization of the spine was obtained using an autologous iliac crest graft and osteosynthesis with an anterior plate. On a second procedure, posterior tumor resection and spinal stabilization were performed. After the 1-year follow-up examination, a new anterior procedure was performed because of tumor recidivity and spine instability. CONCLUSION: Adamantinoma, an extremely rare lesion, is a locally aggressive tumor with slow growth and the potential to metastasize. Although it is an extremely rare occurrence in the spine, adamantinoma should be considered on the diagnosis of tumors of the vertebrae. Neuroradiological examinations are not specific in the differentiation of this tumor from other conditions. This fact, coupled with the limited experience that most physicians in general have in dealing with this tumor, makes the diagnosis and treatment of adamantinoma challenging.
Assuntos
Adamantinoma/diagnóstico , Vértebras Cervicais/patologia , Radiculopatia/etiologia , Neoplasias da Coluna Vertebral/diagnóstico , Adamantinoma/fisiopatologia , Adamantinoma/cirurgia , Transplante Ósseo , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/fisiopatologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Próteses e Implantes , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia , Reoperação , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Os autores estudam um caso de sindrome de Balint por Infarto na encruzilhada temporoparietoocipital esquerda, demonstrado em necropsia. Clinicamente havia sinais lesionais bilaterais desde a instalacao do quadro. Tambem revisam a literatura com enfoque na etiopatogenia da sindrome a partir de seus elementos constituintes: hemi-inatencoes, simultaneagnosia e dissociacao da motricidade ocular do membro superior direito.
