Abstract

VLOK, IJ  and  DUNN, RN. Known primary with secondary disease: is tissue diagnosis necessary?. SA orthop. j. [online]. 2010, vol.9, n.3, pp.35-37. ISSN 2309-8309.

Spinal metastasis as the presenting problem is frequently encountered in oncological practice. This scenario is often complicated by an unknown primary or a previously diagnosed primary some years before. Once identified, the primary is often more accessible than the spine metastasis in terms of biopsy. This raises the issue of whether the metastatic lesion's histology can be inferred from the previously known primary or in fact the current primary's histology. A case is reported which highlights the inherent risks of these assumptions. It identifies the need for adequate specimen when performing a biopsy. The limits of fine needle biopsy must be recognised. Involvement of the cervico-thoracic junction should be recognised as an unstable area with early aggressive surgical intervention necessary to stabilise and prevent deformity and associated neural compression. Finally, local metastatic tissue should always be sent for histological assessment.

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