Abstract
We present a case report of a female patient with metastasis of breast carcinoma to the medullary conus and cauda equina. A 48-year-old woman with a history of breast tumor, suddenly felt severe weakness and numbness of the lower extremities. MRI of the spine disclosed a mass lesion within the medullary conus, with leptomeningeal involvement of cauda equina at the spinal level L1. Laminectomy was performed and partial resection of the medullary conus tumor and especially release of nerve roots of cauda equina was achieved using microsurgical techniques. Her clinical status, especially right leg weakness and sensory loss in the lower extremities have immediately improved but bladder dysfunction remained and she was unable to walk. The histological picture and immunophenotype indicates the presence of metastatic ductal adenocarcinoma of the mammary gland. Patient died 4 months after the spinal cord and cauda equina surgery. To our knowledge, this is the first report of successful surgical treatment of metastatic leptomeningeal infiltration of breast carcinoma.
Highlights
Intramedullary spinal cord metastases (ISCM) are rare
In this paper we present one case of surgically treated ISCM
Positivity of cytokeratin AE1-AE3, cytokeratin 7 and estrogen receptor (Fig. 2); Negativity of progesterone receptor, vimentin and S100 protein; Proliferative activity 10–20%; Histological picture and immunophenotype indicates presence of metastatic ductal adenocarcinoma of mammary gland; Cytogenetic analysis of the tumor was performed using fluorescence in situ hybridisation (FISH): it did not show the numeric abberration of genes or chromosomes frequently involved in breast cancer pathology: Her-2/neu, TOP2A, RB1, p53, C-MYC, cyclin D1, chromosomes 8, 11 or 17
Summary
A 48-year-old woman with a history of breast tumor, suddenly felt severe weakness and numbness of the lower extremities. MRI of the spine disclosed a mass lesion within the medullary conus, with leptomeningeal involvement of cauda equina at the spinal level L1. Laminectomy was performed and partial resection of the medullary conus tumor and especially release of nerve roots of cauda equina was achieved using microsurgical techniques
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