Abstract
BackgroundExtramedullary disease in multiple myeloma often portends a worse diagnosis. In approximately 1% of cases, multiple myeloma may metastasize to the central nervous system as either leptomeningeal involvement or an intracranial, intraparenchymal lesion. Spinal cord metastases, however, are exceedingly rare. We present a case of spinal cord multiple myeloma as well as a literature review of reported cases.Case presentationA 66-year-old African American man with multiple myeloma presented with acute midthoracic pain and lower extremity paresis and paresthesia. Magnetic resonance imaging of the spine revealed two contrast-enhancing intramedullary enhancing lesions in the T1–T2 and T6–T7 cord. Resection with biopsy yielded a diagnosis of metastatic multiple myeloma.ConclusionTo date, only six cases of extramedullary disease to the spinal cord in patients with multiple myeloma have been reported, including our patient’s case. In all cases, neurologic deficit was observed at presentation, and magnetic resonance imaging of the spine revealed an intramedullary, homogeneously enhancing lesion. Current evidence suggests worse prognosis in patients with extramedullary disease to the central nervous system, and treatment paradigms remain debatable.
Highlights
Multiple myeloma (MM) is a hematologic malignancy that accounts for approximately 1.6% of all cancer cases diagnosed in the United States [1]
Neurologic deficit was observed at presentation, and magnetic resonance imaging of the spine revealed an intramedullary, homogeneously enhancing lesion
central nervous system (CNS) Extramedullary hematopoietic (EMH) typically presents as an intracranial metastasis that is postulated to arise from hematogenous spread or contiguous seeding from local lytic bone lesions [4, 5]
Summary
Intramedullary spinal cord metastasis is exceedingly rare and may present as paresthesia and myelopathy in patients with a history of MM. Intramedullary metastases appear as moderately contrast-enhancing lesions on T1weighted images, often with diffuse infiltration across multiple spinal levels. Surgical debulking should be considered to alleviate mass effect on white matter tracts and nerve root compression. Radiotherapy with systemic therapy that ideally has BBB penetration remains a mainstay of treatment for managing this complicated stage of disease
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