Local spread of metastatic vertebral tumors - A histologic study
Local spread of metastatic vertebral tumors - A histologic study
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DOI：
10.1097/00007632-199708150-00020
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发表时间：
1997-08-15
期刊：
影响因子：
3
通讯作者：
Tomita, K
中科院分区：
文献类型：
--
作者：
Fujita, T;Ueda, Y;Tomita, K
研究设计.对19例经全脊椎整块切除术获得的孤立性转移性脊椎肿瘤进行组织学分析。目的：明确椎体肿瘤局部扩散的机制，并确定椎体肿瘤进展的屏障组织。截肢或块切除标本的组织学研究确定了四肢骨和软组织肿瘤的局部扩散模式，并确定了肿瘤扩散的屏障组织。然而，类似的评估脊椎恶性肿瘤是困难的。全脊椎整块切除术治疗原发性脊椎恶性肿瘤和孤立性转移瘤的发展允许收集足够的组织样本，以分析肿瘤局部扩散的模式，使用隔室和屏障的概念。所有椎骨的组织切片均取自整块脊椎切除术后收集的标本。在矢状面上制备连续5 mm切片并进行检查。肿瘤位置分析显示，转移瘤通过侵犯椎体背侧区域的骨髓到达脊柱。前纵韧带、后纵韧带、与椎管邻接的骨膜、黄韧带、椎板和棘突的骨膜、棘间韧带、棘上韧带、软骨终板和纤维环是肿瘤进展的屏障。后纵韧带是最薄弱的屏障组织，在穿通血管处逐渐被肿瘤破坏。即使在屏障组织被破坏后，肿瘤细胞仍被一层薄的纤维反应膜覆盖。肿瘤可通过两条途径扩散至相邻椎体：1）从椎体边缘至纵韧带下相邻椎体; 2）通过椎旁肌至相邻椎板。每个椎骨可以由几个屏障包围的隔室表示。最常见的肿瘤扩散途径是通过后纵韧带进入硬膜外腔。
Study Design. Nineteen solitary metastatic vertebral tumors obtained by total en bloc spondylectomy were analyzed histologically.Objectives. To determine the mechanisms of local spread of vertebral tumors and identify barrier tissues to tumor progression in the vertebra.Summary of Background Date. Histologic studies of specimens resected at amputation or an bloc excision have determined the pattern of local spread of bone and soft tissue tumors in the extremities and identified barrier tissues to tumor spread. However, a similar assessment of vertebral malignancies is difficult. The development of total en bloc spondylectomy for primary vertebral malignancy and solitary metastases has allowed the collection of tissue samples sufficient to analyze the pattern of local spread of tumors, using the concept of compartment and barrier.Methods. Histologic sections of all vertebral elements were prepared from specimens collected after en bloc spondylectomy. Serial 5-mm sections in the sagittal plane were also prepared and examined.Results. Analysis of tumor location showed that metastatic tumors reached the vertebral column by invading the bone marrow of the dorsal region of the vertebral body. The anterior longitudinal ligament, posterior longitudinal ligament, periosteum abutting the spinal canal, ligamentum flavum, periosteum of the lamina and spinous process, interspinous ligament, supraspinous ligament, cartilaginous endplate and the anulus fibrosus served as barriers to tumor progression. The posterior longitudinal ligament was the weakest barrier tissue and was gradually destroyed by the tumor at the point of perforating vessels. Even after destruction of the barrier tissue, tumor cells were covered with a thin, fibrous reactive membrane. Two pathways allowed tumor spread to the adjacent vertebrae: 1) from the edge of the vertebral body to the adjacent vertebral body beneath the longitudinal ligament, and 2) through the paravertebral muscles to the neighboring lamina.Conclusions. Each vertebra can be represented by a compartment surrounded by several barriers. The most common path for tumor spread is through the posterior longitudinal ligament to the epidural space.