Surgical treatment of multiple spine metastases from gastrinoma

 

 Permissions and Reprints

Abstract

Study design: Case report.

Clinical question: To report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma.

Methods: A 43-year-old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma. He had two previous spine metastases to the lower thoracic and lumbar spine, a T11 compressive lesion which required a T9L1 fusion, and an L4 lesion that was treated with chemotherapy and stereotactic radiation. The compression was relieved each time by surgery.

Results: The patient underwent three surgeries in 4 years: (1) debulking and removal of the rib head on the left at T3, and debulking of the tumor at T3 with hemilaminectomy and spinal cord decompression with internal fixation from T1–T5 using posterolateral instrumented fusion and allograft; (2) anterior C7 corpectomy with placement of a cage from C7–T1 with both anterior and posterior fusion of C2C7; and (3) T1–T3 laminectomy, T1–T3 exploration of wound, revision of hardware, T1–T3 removal of spinal tumor, and T3 bilateral transpedicular circumferential decompression. The patient is alive and regained the ability to walk 8 years after initial diagnosis, despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases.

Conclusion: Surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain, weakness and numbness, and while not curative can greatly improve quality of life.

• REFERENCES

• 1 Metz DC, Jensen RT. 2008; Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135 (5) 1469-1492
  CrossrefPubMedGoogle Scholar
• 2 Oberg K, Eriksson B. 2005; Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 19 (5) 753-781
  CrossrefPubMedGoogle Scholar
• 3 Duerr EM, Chung DC. 2007; Molecular genetics of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 21 (1) 1-14
  CrossrefPubMedGoogle Scholar
• 4 Jensen RT, Berna MJ, Bingham DB et al.. 2008; Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer 113 (7) Suppl 1807-1843
  CrossrefPubMedGoogle Scholar
• 5 Jensen RT, Niederle B, Mitry E et al. 2006; Gastrinoma (duodenal and pancreatic). Neuroendocrinology 84 (3) 173-182
  CrossrefPubMedGoogle Scholar
• 6 Nishio K, Nishio A, Nishikawa T et al. 2007; Recurrent gastrinoma in the mesentery 19 years after primary resection. Dig Dis Sci 52 (11) 3104-3108
  CrossrefPubMedGoogle Scholar
• 7 Hirschowitz BI, Simmons J, Mohnen J. 2005; Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study. Clin Gastroenterol Hepatol 3 (1) 39-48
  CrossrefPubMedGoogle Scholar
• 8 Gibril F, Venzon DJ, Ojeaburu JV et al. 2001; Prospective study of the natural history of gastrinoma in patients with MEN1: definition of an aggressive and a nonaggressive form. J Clin Endocrinol Metab 86 (11) 5282-5293
  CrossrefPubMedGoogle Scholar
• 9 Jensen RT. 1998; Management of the Zollinger-Ellison syndrome in patients with multiple endocrine neoplasia type 1. J Intern Med 243 (6) 477-488
  CrossrefPubMedGoogle Scholar
• 10 Gibril F, Doppman JL, Reynolds JC et al. 1998; Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management. J Clin Oncol 16 (3) 1040-1053
  PubMedGoogle Scholar
• 11 Gibril F, Jensen RT. 2005; Advances in evaluation and management of gastrinoma in patients with Zollinger-Ellison syndrome. Curr Gastroenterol Rep 7 (2) 114-121
  CrossrefPubMedGoogle Scholar
• 12 Singh K, Samartzis D, Vaccaro AR et al. 2006; Current concepts in the management of metastatic spinal disease: the role of minimally-invasive approaches. J Bone Joint Surg Br 88 (4) 434-442
  CrossrefPubMedGoogle Scholar
• 13 Sze WM, Shelley MD, Held I et al. 2003; Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy: a systematic review of randomised trials. Clin Oncol (R Coll Radiol) 15 (6) 345-352
  CrossrefPubMedGoogle Scholar
• 14 Gerszten PC, Welch WC. 2000; Current surgical management of metastatic spinal disease. Oncology (Williston Park) 14 (7) 1013-1024
  PubMedGoogle Scholar
• 15 Ryken TC, Eichholz KM, Gerszten PC et al.. 2003; Evidence-based review of the surgical management of vertebral column metastatic disease. Neurosurg Focus 15 (5) E11
  PubMedGoogle Scholar
• 16 Klimo Jr P, Kestle JR, Schmidt MH. 2004; Clinical trials and evidence-based medicine for metastatic spine disease. Neurosurg Clin N Am 15 (4) 549-564
  CrossrefPubMedGoogle Scholar
• 17 Maranzano E, Trippa F, Chirico L et al. 2003; Management of metastatic spinal cord compression. Tumori 89 (5) 469-475
  PubMedGoogle Scholar
• 18 de Herder W, O’Toole D, Rindi G et al. (eds) 2006; ENETS Consensus guidelines for the management of patients with digestive neuroendocrine tumors. Part 1—stomach, duodenum and pancreas. Neuroendocrinology 84 (3) 151-216
  CrossrefPubMedGoogle Scholar
• 19 Klöppel G. 2007; Tumour biology and histopathology of neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 21 (1) 15-31
  CrossrefPubMedGoogle Scholar
• 20 Power N, Reznek RH. 2002; Imaging pancreatic islet cell tumours. Imaging 14 (2) 147-159
  PubMedGoogle Scholar
• 21 Meko JB, Norton JA. 1995; Management of patients with Zollinger-Ellison syndrome. Annu Rev Med 46: 395-411
  CrossrefPubMedGoogle Scholar
• 22 Quatrini M, Castoldi L, Rossi G et al. 2005; A follow-up study of patients with Zollinger-Ellison syndrome in the period 1966–2002: effects of surgical and medical treatments on long-term survival. J Clin Gastroenterol 39 (5) 376-380
  CrossrefPubMedGoogle Scholar
• 23 Yu F, Venzon DJ, Serrano J et al. 1999; Prospective study of the clinical course, prognostic factors, causes of death, and survival in patients with long-standing Zollinger-Ellison syndrome. J Clin Oncol 17 (2) 615-630
  PubMedGoogle Scholar
• 24 Akerström G, Hellman P. 2007; Surgery on neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 21 (1) 87-109
  CrossrefPubMedGoogle Scholar
• 25 Norton JA, Alexander HR, Fraker DL et al. 2001; Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg 234 (4) 495-505
  CrossrefPubMedGoogle Scholar
• 26 Lebtahi R, Cadiot G, Delahaye N et al. 1999; Detection of bone metastases in patients with endocrine gastroenteropancreatic tumors: bone scintigraphy compared with somatostatin receptor scintigraphy. J Nucl Med 40 (10) 1602-1608
  PubMedGoogle Scholar
• 27 Virgolini I, Traub-Weidinger T, Decristoforo C. 2005; Nuclear medicine in the detection and management of pancreatic islet-cell tumours. Best Pract Res Clin Endocrinol Metab 19 (2) 213-227
  CrossrefPubMedGoogle Scholar
• 28 Forrer F, Waldherr C, Maecke HR et al. 2006; Targeted radionuclide therapy with 90Y-DOTATOC in patients with neuroendocrine tumors. Anticancer Res 26 (1B) 703-707
  PubMedGoogle Scholar
• 1 Metz DC, Jensen RT. 2008; Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135 (5) 1469-1492
  CrossrefPubMedGoogle Scholar
• 2 Patchell RA, Tibbs PA, Regine WF et al. 2005; Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet 366 (9486) 643-648
  CrossrefPubMedGoogle Scholar