Intramedullary Spinal Cord Metastasis Research Articles

Spinal Trauma Revealing a Metastatic Medullary Lesion: A Case Report

Introduction and Importance: Intramedullary spinal cord metastases (ISCM) are a rare and devastating complication of malignant disease with a poor prognosis. Prompt and accurate diagnosis is necessary for effective treatment, and magnetic resonance imaging (MRI) is the preferred imaging technique. In this article, a rare case of an ISCM presenting with motor weakness after trauma is described. Case Presentation: The patient showed progressive severe paraplegia and urinary retention, and a thoraco-abdomino-pelvic scan showed a mediastinal pulmonary process and mediastinal adenopathies with adrenal lesions. He was admitted and a total resection of the processus was performed. After surgery, the patient showed partial neurological improvement, but two weeks later, he had a consciousness impairment. A cerebral CT scan showed multiple round lesions, with perilesional edema, and the patient died one month later. Discussion: The article discusses the pathogenic mechanisms of ISCM and its diagnosis, treatment, and management, which are controversial due to the multitude of clinical circumstances and the lack of controlled studies on the efficacy of the different therapeutic approaches. Conclusion: In conclusion, this rare case of Intramedullary Spinal Cord Metastases (ISCM) offers several important take-away lessons for clinicians and researchers alike.

NCMP-06. INTRAMEDULLARY SPINAL CORD METASTASIS OF RENAL CELL CARCINOMA: A COMPARISON OF CASES AND TREATMENT OUTCOMES

Abstract Renal cell carcinoma (RCC) intramedullary spinal cord metastasis (ISCM) is a rare but frequently devastating diagnosis. Due to its rarity, there is currently no clear standard of care for RCC ISCM management. However, with improvements in metastatic RCC management and imaging for early detection of ISCM, we may see a rise in the incidence of RCC patients developing ISCM, for which treatment guidelines are lacking. Here, we aim to add to the growing body of RCC ISCM literature with two cases- one with ISCM managed with surgery, radiation, and immunotherapy, and the other managed with only radiation, immunotherapy, and chemotherapy. Case 1 is a 47 year old male with RCC and lung and bone metastases who underwent nephrectomy, lobectomy, high dose IL-2 therapy, and immunotherapy. He later developed worsening low back pain, and lower extremity paresthesias and weakness. Imaging revealed a thoracic metastasis for which he was started on steroids, underwent surgical resection followed by radiation therapy, and immunotherapy. Serial imaging and clinical exams have not found evidence of ISCM recurrence 5 years after initial resection. Case 2 is a 74 year old female with RCC with cerebellar metastasis who underwent nephrectomy, suboccipital craniotomy with mass resection, radiation therapy, and immunotherapy. 3 years later, she developed neck pain with right arm paresthesias, and imaging revealed cervical spine ISCM. Patient declined surgical intervention, and she was managed with steroids and radiation therapy, followed by chemotherapy. Approximately 5 years after initial ISCM findings, serial imaging and clinical exams have not revealed evidence of disease progression. These cases have several important differences including prior central nervous system metastases, ISCM location, and surgical intervention. However, both have not shown evidence of disease progression at similar time points. We hope these cases add to the small body of cases to move towards developing treatment guidelines.

Prognostic scoring system for surgical treatment of intramedullary spinal cord metastases

Although rare, intramedullary spinal cord metastases (ISCMs) are on the rise, most likely due to prolonged survival and improved outcomes as a result of the advances in cancer treatment for cancer patients. While the management of these lesions remains controversial, surgery for ISCM has recently been advocated for selected patients. We performed a retrospective analysis on 30 patients who were surgically treated for intramedullary spinal cord metastases in order to determine a preoperative prognostic scoring system to guide patient selection for surgical interventions. The scoring system was designed to decide between surgery or other therapeutic procedures. The five parameters selected and employed in the assessment system were: 1) patient’s general condition, 2) age, 3) primary site of the cancer, 4) number of other extramedullary metastases and 5) severity of neurologic symptoms. Prognosis could not be predicted from a single parameter. These five factors were added together to give a prognostic score between 1 and 10. The average survival period of patients with a prognostic score between 1 and 3 points was 3 months; 11 patients with a score of 4 and 5 points had a mean survival of 7.63 months, while patients with a prognostic score between 6 and 10 was 14.8 months. According to our prognostic scoring system for surgical treatment of ISCM, surgery should be performed in those patients who score above 6 points, while radiotherapy/chemotherapy or palliative care is recommended for those who score between 1 and 3 points. A prognostic score of 4 and 5 represents a grey area where surgeons must use their judgment on whether to intervene either medically or surgically. This scoring system could facilitate decision-making in the management of patients with intramedullary spinal cord metastases.

Impact of surgical treatment for intramedullary spinal cord metastasis on neurological function and survival: A multicenter retrospective study by the Neurospinal Society of Japan

BackgroundThis retrospective multicenter study aimed to analyze the characteristics and surgical outcomes of intramedullary spinal cord metastasis (ISCM) and to discuss the controversy regarding its surgical indications. MethodsThis study included 29 ISCM patients who underwent surgery between 2009 and 2020. Biopsy cases were excluded from analysis. For functional and neurological functional assessments, Karnofsky Performance Status (KPS, %) and modified McCormick Scale (MMS, 5-grade scale) scores were determined before and after surgery. Patients were divided into two groups: a mild-to-moderate disability group with preoperative MMS grades 1 to 3, and a severe disability group with preoperative MMS grades 4 to 5. ResultsThe mean preoperative KPS was 45.9, and the mean duration from symptom onset to surgical intervention was 1 month. The ISCM was located in the cervical spine in 10 cases and the thoracic spine in 19 cases. The access route (myelotomy) for ISCM removal was via the posterior median sulcus in 9 cases and via the posterior lateral sulcus in 11 cases, while others were not recorded. The degree of removal was gross total resection in 20 patients (69%), subtotal resection in 0 patients, and partial removal in 9 patients (31%). No significant complications related to the surgical procedures were recorded. Postoperative adjuvant therapy included radiotherapy in 17 patients (58.6%) and chemotherapy or molecular targeted therapy in 13 patients (44.8%). Pathological findings of ISCM showed that colorectal cancer was the most common in 9 cases, followed by lung cancer in 7, renal cell carcinoma in 5, and breast cancer in 2. Twenty-one of the 29 patients (72.4%) were confirmed to have survived 6 months after surgery: 8 of the 10 patients (80%) in the mild-to-moderate disability group and 13 of the 19 patients (68.4%) in the severe disability group. At 6 months after surgery, 3 of the 8 patients (38%) in the mild-to-moderate group were able to maintain or improve their function. Eleven of the 13 patients (85%) in the severe disability group maintained their function despite being severely disabled. ConclusionsThis study suggests that surgical treatment can maintain or improve neurological function in a limited number of patients with ISCM, although it had minimal impact on improving the survival rate after surgery.

Cervical intramedullary spinal cord metastasis from esophageal adenocarcinoma: a case report

BackgroundIntramedullary spinal cord metastasis (ISCM) is a rare pathologic entity. To the best of our knowledge, this is the second case of ISCM due to esophageal adenocarcinoma reported in the literature.Case descriptionWe report a 63-year-old man with a history of surgical removal of an esophageal adenocarcinoma who presented with the Brown–Sequard syndrome. Pan-spinal MRI showed intramedullary cervical lesions with intense homogeneous enhancement on gadolinium injection at C3 level. There were other sites of spinal metastases and one in the brain. We proceeded with the surgical removal of the lumbar metastatic lesion. The patient died 10 days later from respiratory failure.ConclusionISCM from esophageal adenocarcinoma appeared as homogeneous high intensity of the intramedullary lesion in T1 gadolinium. Their prognosis is very poor.

Intramedullary spinal cord metastasis from esophageal squamous cell carcinoma: case report and literature review

BackgroundIntramedullary spinal cord metastasis (ISCM) of malignant tumors rarely happens. To the best of our knowledge, only five cases of ISCM from esophageal cancer have been reported in literature. We here report the sixth descripted case of ISCM from esophageal cancer.Case presentationA 68-year-old male presented with weakness of right limbs and localized neck pain two years after diagnosed esophageal squamous cell carcinoma. The gadolinium enhanced Magnetic resonance imaging (MRI) of cervical spine showed a mixed-intense intramedullary tumor with typical more intense thin rim of peripheral enhancement in C4-C5. The patient died fifteen days after diagnosis of irreversible respiratory and circulatory failures. An autopsy was refused by his family.ConclusionsThis case highlights the importance of gadolinium enhanced MRI for diagnosis in ISCM. We believe that early diagnosis and surgery for selected patients shows helpfulness to save their neurologic function and improve quality of life.

Intramedullary Spinal Cord Metastases from Breast Cancer: A Systematic Review.

Intramedullary spinal cord metastases (ISCM) are deemed extremely aggressive, as confirmed by the low life expectancy since the diagnosis. Up to 26.5% of total ISCM stem from breast cancer (BC), representing the second most frequent primary site after the lung. The increasing incidence of BC and the widespread use of MRI for the diagnosis could therefore lead to an earlier diagnosis and, therefore, to a progressively longer survival in patients affected by ISCM from BC. This systematic review is intended to provide an orientation through a management algorithm for the most appropriate therapeutic approach in these patients. The research strategy initially relied on title and abstract analysis. The article's full text was retrieved for further investigation if the title and abstract met the inclusion criteria. The extracted data included the following: authors, publication time, study design, patient characteristics, ISCM location, treatment modalities, time interval from initial cancer diagnosis to ISCM diagnosis, clinical outcomes, and survival time. This systematic search regarding ISCM from BC yielded 574 articles. After screening, a total of 44 studies were included in this systematic review. A total of 123 patients were evaluated. The mean patient age was 53.2 years with a standard deviation of 10.4 years. Female patients were 122. There was only one male patient. ISCM from BC have a better prognosis than lung metastases and, thanks to recent advances in diagnostic imaging and intraoperative planning and neuromonitoring, an early diagnosis and a prompt multidisciplinary treatment may be accomplished. Prospective studies to generate evidence-based data regarding the most appropriate treatment for ISCM are mandatory.

Intramedullary spinal cord metastases: current state of the problem

Intramedullary metastases are a rather rare manifestation of the underlying cancer. Their presence indicates an unfavorable prognosis and leads to a noticeable decrease in the quality of life. The absence of pathognomonic symptoms prevents the rapid and accurate identification of this pathology, which leads to a late diagnosis. The main methods of treating spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy. Refining diagnostic algorithms and optimizing protocols for managing patients with intramedullary metastases can help play a role in improving overall prognosis and patient survival. The review covers the epidemiology, the mechanisms of metastasis, the clinical picture, modern methods of diagnosis and treatment of intramedullary metastases, as well as the outcomes of this pathology. The main methods of treatment of spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy.

Intramedullary spinal cord metastases from non-small cell lung carcinoma (NSCLC) associated with carcinomatous meningitis: a case report

Abstract Background: Carcinomatous meningitis with metastases to the spinal cord [intramedullary spinal cord (IMSC)] is very rare, and a quick intervention to management of these patients is important in preventing neurological deterioration. Methods: We report a case of IMSC metastases from a stage IV non-small cell lung carcinoma in a 57-year-old man who presented with Brown-Sequard syndrome along with multiple brain metastases with associated carcinomatous meningitis and managed with urgent palliative external beam radiation therapy. Conclusion: A quick, short course of palliative radiation therapy for inoperable patients with IMSC metastases provides improvement in neurological function in the management of these oncologic emergencies in patients with short survival times.

18-F-FDG PET/CT Finding of Intramedullary Spinal Cord Metastases from Cerebellar Medulloblastoma - Case report

A 20- years old female patient, diagnosed case of right cerebellum medulloblastoma, post excision, adjuvant chemotherapy, and radiotherapy in 2018. Presented with right eye swelling in 2021. Brain MRI revealed aright frontal parasagittal mass lesion and left lateral cerebellar mass, highly suggestive of disease recurrence. Total spine MRI showed interval development of new intra-axial lesion at the level of the cervical medullary junction, highly suggestive of Intramedullary spinal cord metastasis (Figure 1).

NCMP-05. RARE CASE OF INTRAMEDULLARY SPINAL CORD METASTASIS AND CANCER-RELATED STROKE SECONDARY TO NASOPHARYNGEAL CARCINOMA

Abstract INTRODUCTION Central nervous system (CNS) metastasis from nasopharyngeal carcinoma (NPC) is rare and presents with high morbidity and mortality. As a rare entity, a few patients with CNS metastasis from NPC have been reported, and no studies were available on treatment and prognosis. Based on our clinical experience, early diagnosis with incorporation of a clear palliative plan is imperative in providing holistic care for patients with locally-invasive and metastatic nasopharyngeal carcinoma. CASE REPORT Our study reports a case of a 48-year-old Filipino male with known NPC Stage IVB who developed acute symptoms of constipation, urinary retention, and bilateral lower limb weakness and numbness. Magnetic resonance imaging (MRI) showed intramedullary lesions in multiple segments of the spinal cord. Steroid and radiotherapy of the spine were initiated with noted transient improvement of the motor strength. Subsequently, he developed cancer-related stroke. The patient progressively deteriorated despite best medical care. To our knowledge, this is the fourth case of intramedullary spinal cord metastasis from NPC reported worldwide but the first one in the Philippines.

Palliative Radiation Therapy for Intramedullary Spinal Cord Metastasis.

The purpose of this study was to retrospectively review the outcomes of intramedullary spinal cord metastasis (ISCM) and identify predictors for ambulation after radiotherapy (RT). We analyzed 16 lesions in 15 patients treated with RT for ISCM at our clinic from October 2009 to April 2020 to evaluate predictors for improved ambulation following RT. The primary diseases included nine cases of lung cancer, two cases of breast cancer, and several others. The RT schedule was primarily 30 Gy/10 fractions in seven cases, while others were applied to nine cases. The median overall survival time was 99 days. After RT, all seven patients who could walk prior to RT were still able to walk (100%), whereas only two of nine patients who could not walk prior to RT were able to walk (22%, p=0.004). Ambulation prior to RT was a significant predictor of ambulation ability after RT.

Infiltration of the spinal cord and peripheral nerves in multiple myeloma.

BackgroundMultiple myeloma (MM) is a hematological malignancy, and intramedullary spinal cord metastasis is extremely rare.MethodsClinical and radiological data were collected from electronic medical records as well as a literature review of reported cases.ResultsWe report a rare case of IgA-LAM stage IIB MM with involvement of the spinal cord and peripheral nervous system. Laboratory studies showed elevated levels of serum β2-macroglobulin and cerebrospinal fluid protein. Electromyography revealed a demyelinating process with motor conduction blocks. On MRI, the lesions of MM bone marrow are characterized as a type of diffuse infiltration. MR neurography demonstrated an enhanced nodule in the thoracic segment with swelling of the cervicothoracic segments of the spinal cord. Moreover, swelling and hypertrophy of the entire nerve branchial, lumbosacral plexus, and cauda equina were detected, accompanied by myofascitis and denervated muscles. Ultimately, the condition of the patient deteriorated quickly and she died with a diagnosis of refractory MM.ConclusionMRI not only has the advantage of displaying the primary involved site of the bone marrow but also facilitates detecting extramedullary hematopoietic MM, such as infiltrating sites of the central and/or peripheral nervous system.

Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications-a multicenter study.

Intramedullary spinal cord metastasis (ISCM) is a rare event in the course of advanced malignancy. Management of these lesions remains controversial. Recently, surgery for ISCM has been advocated for selected patients. We performed a retrospective analysis of the clinical course, complications, and outcome of 30 patients surgically treated for ISCM. Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and postoperative neurological status, and extent of the tumor resection were also analyzed. Predominant tumor location was thoracic, followed by cervical and conus medullaris. Lung cancer constituted the majority of primary malignancies. In 9 cases, one of the indications for spinal surgery was to obtain a histopathological diagnosis. On admission, all patients presented with neurological symptoms suggestive of myelopathy. After surgery, 18 patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits; 6 patients were unchanged, while 6 patients exhibited postoperative deterioration. Median survival time after surgery was 9.9 months. Age > 70 years old, presence of systemic metastases, preoperative neurological non functional status, and lung cancer as primary tumor were all factors associated with a worse survival prognosis. This study did not show a clear survival difference between gross total and subtotal ISCM tumor resection. Patients who underwent gross total resection had a worse functional outcome with respect to patients with only partial resection. Gross total resection with low morbidity must be the surgical target, but when not possible, subtotal resection and adjuvant therapy are a valid therapeutic option.

Intramedullary spinal cord metastasis of malignant melanoma:Two cases with rim signs in contrast-enhanced magnetic resonance imaging: A case report.

Spinal cord metastasis of malignant melanoma is mostly caused by the invasion of the spinal cord by malignant melanoma. However, direct metastasis in the spinal cord is rare and difficult to diagnose accurately. A few diagnostically valuable findings of intramedullary spinal cord metastases (ISCMs) have been published. However, a highly specific finding of ISCMs of all carcinomas is the ‘rim sign’, which signifies the enhancement of the edge-dominant effect of the lesion in contrast-enhanced MRI. The objective of this case series was to examine the ratio of ISCMs of malignant melanoma with an indication of rim signs in contrast-enhanced MRI. The present report describes two cases of ISCMs of malignant melanoma in which the rim sign in contrast-enhanced MRI was useful for diagnosis.

Intramedullary spinal cord metastases: Report of three cases and review of the literature

Intramedullary spinal cord metastases (ISCM) is a rare, but devastating complication of malignant disease. Prognosis is poor, with an overall median survival (OS) of 4 months from the time of diagnosis. Yet, ISCMs are being increasingly diagnosed, related to advances and increased use of imaging and therapies that prolong survival in patients with cancer. Prompt and accurate diagnosis of ISCM is necessary for effective treatment, and magnetic resonance imaging (MRI) is the preferred imaging technique. The optimal management of these patients is controversial because of the multitude of clinical circumstances and the lack of controlled studies on the efficacy of the different therapeutic approaches. Increased awareness of this rare entity may lead to an earlier diagnosis at a stage when neurological deficits are reversible, and therefore, more effective palliation may be achieved. Therefore, we carried out this retrospective research of 3 observations of ISCM, associated with a detailed review of the literature describing the diagnostic, therapeutic and evolutionary characteristics of this special rare entity.

An advanced-stage large-cell neuroendocrine lung carcinoma with intramedullary spinal metastases detected by positron emission tomography

Large-cell neuroendocrine carcinoma (LCNEC) is a rare form of lung cancer with an aggressive behavior that frequently metastasizes to liver, brain, and bone. Intramedullary spinal cord metastasis (ISCM) is a rare clinical presentation of solid cancer and always indicates a dismal prognosis. This article presents a 72-year-old male patient diagnosed with an advanced-stage LCNEC who initially presented with ISCM that was diagnosed by positron emission tomography-computed tomography (PET-CT). This case demonstrates the diagnostic performance of PET-CT for ISCM. PET may be an alternative diagnostic modality for patients intolerant or unable to receive magnetic resonance imaging study to detect ISCM in those with LCNEC.

Intramedullary Metastasis of Medulloblastoma: A Case Report

Medulloblastoma (MB) is a malignant brain tumor with a usual potential for leptomeningeal spread. Intramedullary metastases of MB are rare and there are very few cases reported in the literature. Here, we report the case of an 18-year-old man with intramedullary spinal cord metastasis of MB occurring 9 years after the first diagnosis. The patient presented a 2-month history of progressive weakness in both lower limbs associated with urinary incontinence. Magnetic resonance imaging (MRI) demonstrated a large intramedullary spinal cord tumor extending from T10 to L1. The patient underwent surgical decompression and adjuvant therapy. Histological examination confirmed the diagnosis of classic MB metastasis. Postoperatively, the neurological status was stationary. Intramedullary metastasis of medulloblastoma is rare and difficult to manage with a poor prognosis. Comprehensive studies on the medulloblastoma dissemination mechanisms and clinical trials are needed to assess combined therapeutic approaches on metastases of MB.

“Twins Intramedullary Tumors”: Case Report of a Double Spinal Metastasis from Breast Cancer. Technical Nuances and Review of the Literature

Intramedullary spinal cord metastases (ISCMs) represent a rare complication of malignancies and have been identified...

Volumetric-modulated arc stereotactic radiotherapy for intramedullary cervical spinal cord metastases: Report of two cases

Volumetric-modulated arc stereotactic radiotherapy for intramedullary cervical spinal cord metastases: Report of two cases