Breast cancer presenting with intramedullary cervical spinal cord metastasis

Abstract

A 45-year-old female patient was admitted to our hospital with complaints of weakness in her legs. There was no disturbance in sphincter function. Neurologic examination revealed generalized weakness and numbness in all four limbs. Examination of cranial nerves and tendon reflexes revealed normal functioning. Magnetic resonance imaging of the cervical spine demonstrated a 3 cm×0.9 cm×1.1 cmmass between the inferior two thirds of C2 and superior third of C3 (Figure). The mass was isointense on T1-weighted images, hyperintense on T2-weighted images, and homogeneously enhancing on post-contrast T1-weighted images. Sagittal T2-weighted images showed a pencil-shaped hyperintensity extending proximal to the lesion (Figure). The features were typical for intramedullary spinal cord metastasis (ISCM) [1]. An Ffluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) scan showed a left breast lesion and multiple liver lesions. The patient underwent biopsy of the left breast mass and a liver mass. The breast mass was found to be a poorly differentiated, estrogen/progesterone (ER/ PR)-negative infiltrating ductal carcinoma, and an enlarged 1.6-cm left axillary lymph node biopsy revealed metastatic adenocarcinoma. The liver mass biopsy was reported to be an ER/PR-negative adenocarcinoma, consistent with metastatic breast cancer. The patient was started on dexamethasone, chemotherapy, and local external beam radiation therapy to the cervical spinal cord. After completion of the radiotherapy, there was improvement in the weakness and numbness of the extremities. The patient remained stable neurologically for 2 months after the diagnosis of breast cancer until death due to the liver metastases. Breast cancers can present with symptoms of the spinal cord metastasis. Intramedullary spinal cord metastasis of breast cancer is an extremely rare but severe condition that can cause neurologic deficits. Metastatic breast cancer should be considered when the typical features of ISCM are seen on spinal magnetic resonance imaging.