Metastatic cardiac angiosarcoma of the cervical spine - Case report

Study Design. A case report of metastatic cardiac angiosarcoma of the cervi cal spine. Objectives. To show that this rare spine tumor behaves in the same manner a s an arteriovenous malformation and embolization, which can allow for succe ssful spine surgery, and to discuss the natural history and rarity of this tumor. Summary of Background Data. Primary angiosarcoma of the heart is a very rar e tumor, with fewer than 200 reports in the English literature and nothing reported in the spine literature. Results. The patient in this study initially sought treatment for neck pain , left arm pain, and weakness 17 months after cardiac surgery and subsequen t chemotherapy. A cervical computed tomography scan demonstrated a C5 lytic vertebral body tumor with intracannilicular extension and cord compression . An anterior cervical approach was made, but the tumor was too vascular to resect, and surgery was aborted. The C5 vascular vertebral body metastasis subsequently was embolized successfully by an interventional neuroradiolog ist. Reoperation via an anterior approach with corpectomy, cadaveric fibula , and anterior locking plate internal fixation was successful, producing ma rked improvement in the patients' symptoms. Conclusion. Spinal involvement by primary cardiac angiosarcoma is very rare , and this is only the second operative case ever reported. The vascular na ture of this tumor makes it behave in a manner similar to that of a high-fl ow arteriovenous malformation. Surgery should not be undertaken before preo perative angiography and embolization. The dismal prognosis for this rare m alignancy is discussed.