Intramedullary Spinal Cord Metastasis Research Articles

Conus medullaris metastasis in breast cancer: report of a case and a review of the literature

Intramedullary spinal cord metastasis is quite rare. This report presents the case of a female patient with metastasis of the conus medullaris from breast cancer, presenting with paraplegia and sphincter dysfunction. Bladder dysfunction improved after removal of the conus mass. This report is the seventh case of conus medullaris metastasis from breast cancer and the first review of clinical outcome, survival time and other data of all these 7 cases. This study also reviewed cases of intramedullary spinal cord metastasis arising from breast cancer in regions other than the conus medullaris in the literature. Longer survival time resulted from surgery in contrast to those without surgery in the latter group.

Intramedullary spinal cord metastasis from prostate carcinoma: a case report

IntroductionAlthough vertebral and epidural metastases are common, intradural metastases and intramedullary spinal cord metastases are rare. The indications for the treatment of intramedullary spinal cord metastases remain controversial. We present the first biopsy-proven case of an intramedullary spinal cord metastasis from adenocarcinoma of the prostate.Case presentationOur patient was a 68-year-old right-handed Caucasian man with a Gleason grade 4 + 3 prostate adenocarcinoma who had previously undergone a prostatectomy, androgen blockade and transurethral debulking. He presented with new-onset saddle anesthesia and fecal incontinence. Magnetic resonance imaging demonstrated a spindle-shaped intramedullary lesion of the conus medullaris. Our patient underwent decompression and an excisional biopsy; the lesion’s pathology was consistent with metastatic adenocarcinoma of the prostate. Postoperatively, our patient received CyberKnife® radiosurgery to the resection cavity at a marginal dose of 27Gy to the 85% isodose line. At three months follow-up, our patient remains neurologically stable with no new deficits or lesions.ConclusionsWe review the literature and discuss the indications for surgery and radiosurgery for intramedullary spinal cord metastases. We also report the novel use of stereotactic radiosurgery to sterilize the resection cavity following an excisional biopsy of the metastasis.

Spinal Cord Disease in Patients With Cancer

Spinal cord disease is not uncommon in patients with systemic cancer. Most cases are due to epidural tumor metastases with resulting cord compression, although intramedullary spinal cord metastases, radiation myelopathy, and myelopathic complications of chemotherapy must be considered. Techniques for surgical decompression of the spinal cord in patients with epidural tumor have improved significantly over the past decade. Several studies have demonstrated improved neurologic outcome in a subset of patients with epidural spinal cord compression treated surgically. This article outlines the clinical features, radiographic findings, and differential diagnosis of spinal cord disease in patients with cancer and describes the therapeutic approach to these patients. Early identification and treatment of patients with epidural spinal cord compression is critical to maintaining neurologic function and preserving quality of life.

Metachronous brain and intramedullary spinal cord metastases from nonsmall-cell lung cancer: A case report

A 44-year-old man had a brain tumor secondary to lung adenocarcinoma and underwent craniectomy to remove the brain tumor. After postoperative whole-brain radiation therapy, he underwent pneumonectomy followed by chemotherapy, mediastinal radiotherapy, and target therapy for lung cancer. Thirty-six months after the initial brain surgery, he suffered from neck pain and right upper limb numbness that rapidly progressed to upper extremity weakness and paralysis in 2 months. Magnetic resonance imaging demonstrated an intramedullary spinal cord lesion at the C4 level. Laminectomy and gross intramedullary tumor removal were performed. The patient’s neurological function improved after the operation. Nevertheless, 4 months after the intramedullary tumor removal, he began to show multiple metastases. Unfortunately, the patient died from respiratory failure 8 months after diagnosis with intramedullary spinal cord metastasis. In this case, early diagnosis and aggressive surgical treatment combined with postoperative radiotherapy and chemotherapy might have provided this patient with a prolonged survival and better quality of life.

Isolated Solitary Intramedullary Spinal Cord Metastasis Presenting as the First Manifestation of Small-Cell Lung Cancer: Report of a Rare Case

Background. Intramedullary spinal cord metastases presenting as the first manifestation of malignancies are extremely rare lesions. Case Description. The authors report a 74-year-old woman who presented with an isolated intramedullary spinal cord metastasis which presents as first manifestation of malignancy without central nervous system and/or other organ involvement. She went under surgery, and after histopathological evaluation, primary focus was determined in lung in positron emission tomography. She is still alive after 9 months since the first diagnosis of primary focus. Conclusion. In patients with solitary intramedullary lesion in the spinal magnetic resonance imaging, whole-body investigation might help for diagnosis of primary focus and approach to treatment.

Intramedullary Spinal Cord Metastasis from Papillary Thyroid Carcinoma

Intramedullary spinal cord metastasis (ISCM) is an uncommon complication of malignancy. ISCM from thyroid cancer is extremely rare, only a few cases had been reported and most were found at autopsy. Here we report a patient with progressive lower leg weakness due to ISCM from papillary thyroid carcinoma who had a good response to surgery. A 44-year-old woman presented with bilateral lower leg pain in December 2009. She underwent a total thyroidectomy in 1997 because of large mass in the right neck, which was diagnosed as papillary thyroid carcinoma. She had repeated I-131 therapies, but brain metastasis developed in 2002. When she was admitted, lower leg pain and weakness progressed rapidly. We performed magnetic resonance of the spine and whole-body fluorodeoxyglucose (FDG)-positron emission tomography scan, which demonstrated a 2×6 cm intramedullary mass enhanced by gadolinium with FDG-uptake. She underwent emergency laminotomy with subtotal tumor removal. Pathology revealed metastatic papillary thyroid carcinoma. After the emergent operation she could walk without help. We report a patient with ISCM from papillary thyroid carcinoma. Surgical resection should be considered in patients with ISCM from papillary thyroid carcinoma. Early diagnosis and surgical resection could improve the quality of life and the neurologic deficits.

Intramedullary spinal cord metastasis from colonic carcinoma presenting as Brown-Séquard syndrome: a case report

IntroductionIntramedullary spinal cord metastasis is very rare. The majority are discovered incidentally during autopsy. Most symptomatic patients present with rapidly progressive neurological deficits and require immediate examination. Few patients demonstrate features of Brown-Séquard syndrome. Radiotherapy is the gold-standard of therapy for Intramedullary spinal cord metastasis. The overall prognosis is poor and the mortality rate is very high. We present what is, to the best of our knowledge, the first case of Intramedullary spinal cord metastasis of colorectal carcinoma presenting as Brown-Séquard syndrome.Case presentationWe present the case of a 71-year-old Caucasian man with colonic adenocarcinoma who developed Intramedullary spinal cord metastasis and showed features of Brown-Séquard syndrome, which is an uncommon presentation of Intramedullary spinal cord metastasis.ConclusionThis patient had an Intramedullary spinal cord metastasis, a rare form of metastatic disease, secondary to colonic carcinoma. The metastasis manifested clinically as Brown-Séquard syndrome, itself a very uncommon condition. This syndrome is rarely caused by intramedullary tumors. This unique case has particular interest in medicine, especially for the specialties of medical, surgical and radiation oncology. We hope that it will add more information to the literature about these entities.

Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma

Intramedullary spinal cord metastases (ISCM) are rare spinal cord neoplasms associated with severe neurological deterioration and poor life expectancy. However, their incidence is expected to increase as a result of advances in diagnostic techniques and longer survival of patients with cancer due to improvements in cancer therapy. Reports on ISCM from primary urothelial carcinoma are virtually non existent. We report a 74-year-old male patient with a significant history of a high-grade urothelial carcinoma who presented with progressive back pain and concomitant weakness, grade 3–4/5 proximally and 0–1/5 distally, and distal hyperesthesia and hyperalgesia, particularly of the left lower limb. MRI revealed a contrast-enhancing intramedullary lesion at Th11/Th12. Laminectomies of Th11/Th12 and lesion resection were performed. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. Subsequently the patient developed multiple brain metastases. Radiation therapy was refused by the patient. We conclude that ISCM are devastating complications of systemic cancer. Early and thorough diagnosis, as well as carefully considered and prompt therapy, is important for minimizing the patient’s functional deficit, thus improving quality of life.

Intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma

A rare case of intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma was described. A 57-year-old man had a nephrectomy for renal cell carcinoma in the left kidney 5 years ago, and no recurrence or metastasis was found in computed tomography and bone scintigraphy. Later, the patient was presented as having bilateral shoulder pain and severe palsy of bilateral upper and lower extremities, and a solitary tumor in the intramedullary spinal cord was found at the C4 level. Excision of the tumor was performed and the intraoperative pathological diagnosis suspected the tumor to be hemangioblastoma. However, a final pathological examination revealed characteristics consistent with metastasis of renal cell carcinoma. Although the patient’s neurological condition and neuralgia initially slightly deteriorated postoperatively, they then gradually improved. Twenty-two months after the operation, a follow-up magnetic resonance imaging showed no recurrence of intramedullary spinal cord tumor, and there were no other metastases found in other organs.

Intramedullary conus medullaris metastasis of periurethral adenocarcinoma

Intramedullary spinal cord metastasis to the conus medullaris is very rare. We report a 44-year-old woman with an intra-axial conus medullaris metastasis from periurethral adenocarcinoma. To our knowledge, this is the first report in the literature. We also discuss the clinical features, possible pathophysiological mechanisms and treatment options for intramedullary spinal cord metastasis to the conus medullaris.

Radiotherapy for Patients with Symptomatic Intramedullary Spinal Cord Metastasis

The study was performed to evaluate radiotherapy for patients with intramedullary spinal cord metastasis (ISCM) and to identify the clinical features of ISCM. The subjects were 18 patients (8 men, 10 women) with ISCM who underwent radiotherapy between September 2002 and February 2008. The primary lesions were lung cancer in 8 patients (2 small cell, 6 non-small cell), breast cancer in 6, malignant melanoma in 2, renal cell carcinoma in 1, and rectal cancer in 1 patient. Diagnosis, symptoms and survival of these patients were compared with those for 544 patients with vertebral metastases who underwent radiotherapy at the same institute between September 2002 and November 2006. In the 18 patients with ISCM, the 6-month survival rate after radiotherapy was 36% and the median survival period was 4.0 months. Ten patients had neurological improvement or pain relief after radiotherapy. Brain metastases were six fold more frequent in the patients with ISCM than in those with vertebral metastasis [89% vs. 15%, p = 0.001]. At the time of radiotherapy, back pain in patients with vertebral metastasis was more frequent [97% vs. 33%, p = 0.001] but neurological deficits were less common [24% vs. 100% , p = 0.001]. Most ISCM cases were diagnosed by contrast-enhanced MRI, with detection by contrast-enhanced CT in only 3/18 cases (17%). ISCM has a poor prognosis and most patients have neurological deficits that impair quality of life. Early diagnosis by MRI is important for suspected ISCM to allow initiation of radiotherapy before development of neurological deficits.

Current Insights into Surgery for Intramedullary Spinal Cord Metastases: A Literature Review

Intramedullary spinal cord metastasis (ISCM) is the rarest type of CNS involvement by systemic malignant tumours. Optimal management of patients with ISCMs remains ambiguous. Based on two cases reported from our department, we focused on the strategy for intramedullary spinal cord metastases surgery.

Brain and Intramedullary Spinal Cord Metastasis From Squamous Cell Cervical Carcinoma

Cervical cancer is the most common gynecologic malignancy among women in Taiwan. The annual incidence is approximately 1,000 cases. The metastasis route of carcinoma of the cervix usually extends locally, through the lymphatic drainage pathway from pelvic to paraaortic lymph nodes, or by the hematogenous pathway to distant sites [1]. Metastases to the central nervous system from cervical cancer are very rare. They are usually seen late in the course of the disease, and indicate a poor prognosis. Owing to the rarity of this event, there are very few reports in the literature regarding the optimal management of these patients. We report the case of a woman with a cervical squamous cell carcinoma (SCC), stage IB2 postradical hysterectomy with left temporal lobe and intramedullary spinal cord metastasis. A 39-year-old Vietnamese woman, gravid 1, para 1, presented at our clinic with a 6-month history of irregular menses with vaginal bleeding. A diagnosis of SCC of cervix FIGO stage IB2 was made (Figure 1). The value of SCC antigen was 0.7 ng/mL (normal range, 0–1.5 ng/ mL). She was then treated with a radical hysterectomy and bilateral pelvic lymph node dissection. Pathology revealed moderate differentiated SCC, non-keratinized with lymphovascular space invasion (LVSI) and no pelvic lymph node metastasis (Figure 2). Because of the LVSI, she was treated with pelvic radiotherapy (200 cGy fractions, total dose of 5,600 cGy in Box technique), followed by brachytherapy. The value of SCC antigen after radiotherapy was 1.1 ng/mL. Six months after the completion of treatment, she presented with severe headache. Computed tomography revealed a solitary brain tumor measuring 50×43× 57 mm, with surrounding hypodensity at the right temporal lobe with midline shift (Figure 3). She received a craniotomy with removal of brain tumor. Pathology revealed metastatic SCC (Figure 4). After the operation, she received whole-brain radiotherapy with a total dose of 5,040 cGy. The value of SCC antigen was <0.3 ng/mL then. Unfortunately, three months after BRAIN AND INTRAMEDULLARY SPINAL CORD METASTASIS FROM SQUAMOUS CELL CERVICAL CARCINOMA

Intramedullary Spinal Cord Metastasis in a Patient with Colon Cancer: A Case Report

Intramedullary spinal cord metastasis (ISCM) is both a rare and devastating event, since it is clinically evident in 0.1-0.9% of cancer patients and the mortality rate at 3-4 months is 80%. We present the case of a woman with colon cancer who developed ISCM while on chemotherapy for metastatic disease. The patient presented with paralysis of both legs, weakness in the upper arms, and urinary retention. The diagnosis of ISCM at the level of C6-C7 was made with magnetic resonance imaging of the whole spine. Due to the fact that the patient had an established lower limb paralysis and a poor overall clinical status, external beam radiotherapy (RT) was administered, achieving stabilization of symptoms. ISCM should be diagnosed and managed as early as possible, since this may result in improvement of neurological deficits. RT is the treatment of choice in most cases, with surgery reserved for selected patients. Recent published data suggest that surgery may result in an improved survival. However, no firm recommendations can be made due to the lack of controlled comparative clinical trials.

Intramedullary spinal cord metastases of malignant melanoma: an autopsy case report and review of the literature

Compared with brain metastasis of malignant melanoma (MM), spinal metastasis, and in particular intramedullary spinal cord metastasis (ISCM), is extremely rare. A 78-year-old female patient suffered from disturbance of gait and mild dementia. Radiological investigations revealed multiple hemorrhagic lesions in the brain. She underwent surgical resection of a right parietal lesion, the diagnosis of which was MM. Re-examination of her past history revealed that the patient had undergone surgical resection of a nevus on her left cheek 3 years previously, the diagnosis of which had been MM. After she had died of the tumor 3 months later, complete autopsy was performed. Multiple ISCMs with hemorrhage were detected in the cervical, thoracic, and lumbar cord. We found 9 cases of ISCM of MM in the literature, 5 of which were located in the cervical cord, 3 in the thoracic cord, and 1 in the lumbar cord. One difference between the findings noted in the literature and those in the present case involved the cross-sectional location of metastases in the spinal cord. In the present case, it appeared that postoperative management for the left buccal melanoma, which did not include adjuvant therapy, affected the postoperative clinical course. The prognosis was also affected by overlooking of ISCM. The brain metastases in the present case induced deterioration of her neurological symptoms rapid enough that the possibility of ISCM was not considered. On evaluation of tumor spread from MM, it is important to take into account not only intracranial metastases but ISCM as well.

INTRAMEDULLARY SPINAL CORD METASTASES: REVIEW OF THE LITERATURE

To review the epidemiology, dissemination, clinical presentation, diagnosis, treatment, survival and functional outcome of intramedullary spinal cord metastases (ISCM). Literature review of all surgically treated cases of ISCM and all described cases of ISCM of breast carcinoma. 42 references to 87 surgically treated cases of ISCM were found, 13 references to 27 cases with diagnosed and treated ISCM of breast carcinoma. In only 9 cases of spinal cord metastases of breast cancer was surgical resection of ISCM done (10% of all surgically treated ISCM). Three treatment modalities are available for ISCM: radiotherapy, chemotherapy, and surgery. The gold standard remains radiotherapy. Microsurgical resection of a focal intramedullary mass appears to be feasible and should be considered in selected cases. Patients who have no evidence of widespread organ metastases or multiple intramedullary lesions and who have a life expectancy of at least a few months with tumours of non-lymphoma histology should be considered for tumor resection. In conclusion, ISCM are difficult to treat lesions, but early diagnosis, careful surgical management and maintenance therapy may substantially contribute to a satisfactory functional outcome and prolonged survival.

Myelopathies in Patients With Cancer

Myelopathy is a devastating neurologic complication of cancer. The resulting pain, paralysis, and incontinence can turn a patient with cancer from a functioning individual to one who is confined to a chair or bed. Early diagnosis and appropriate therapy can prevent or ameliorate these symptoms and improve both duration of survival and quality of life. Accurate neurologic assessment of patients is crucial for early diagnosis and correct therapy. Myelopathy in patients with cancer is not rare. Epidural spinal cord compression (SCC) affects an estimated 5% of patients with cancer; other disorders such as intramedullary spinal cord metastases, adverse effects of therapy, and paraneoplastic spinal cord syndromes, although less common, are equally devastating. Because of space limitations, this review addresses the pathophysiology, clinical findings, diagnosis, and treatment of only some of the myelopathies that affect patients with cancer (Table 1). Because of new data, epidural SCC and paraneoplastic syndromes are emphasized.

Coexistent intramedullary spinal cord and choroidal metastases in ovarian cancer

Involvement of intramedullary spinal cord and the choroid by ovarian cancer is rare, and coexistence of metastases at these sites is extremely rare and has never been reported. This condition rapidly progresses to a neurological emergency; however, an efficient standard treatment method is not available for this rare condition. The case presented herein is of a female patient with stage II, poorly differentiated serous cystadenocarcinoma of the ovary. She presented with blindness and other neurologic complaints during the course of treatment for a recurrence at 50 months after the primary surgical treatment for the tumor. Magnetic resonance imaging (MRI) revealed intramedullary spinal cord metastasis and choroidal metastasis, coexisting with multiple brain metastases and intra-abdominal lesions. Neurological emergency was prevented by administering whole-brain irradiation therapy followed by systemic chemotherapy. Early diagnosis and multidisciplinary treatment, including radiotherapy and chemotherapy, may offer good palliation for such unusual metastases of ovarian cancer.

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A 34-year-old previously healthy man presented with acute transverse lumbar myelopathy and MRI evidence of a longitudinally extensive spinal cord lesion (LESCL) from the upper thoracic cord extending down to the conus medullaris. Gadolinium-DTPA enhancement revealed a clearly demarcated enhanced nodule confined to the level of the 11th thoracic vertebral body (T11), which might have caused longitudinally extensive edema in the spinal cord. Histopathological appearance of adenocarcinoma of the nodule led to the ultimate diagnosis of lung cancer. Intramedullary spinal cord metastasis in a young patient without previously-diagnosed malignancy is a rare disorder, but should be listed up as a cause of LESCL.

Intramedullary Spinal Cord Metastasis (ISCM) Arising from Small Cell Lung Cancer (SCLC)

Intramedullary spinal cord metastases occurring from any malignant tumor are usually accompanied by frequent metastases in the intracranium. The clinical features of this disease have been described as the rapid progression of neurologic deficit that can lead to complete paraplegia. In this case, the authors treated a 76-year-old woman, who was diagnosed with an intramedullary spinal cord metastasis arising from a small cell lung cancer without an invasion of the brain, with decompressive surgery and posterior instrumentation. The patient suffered from weakness of her legs, walking difficulties, and urinary and fecal incontinence. Her preoperative neurologic symptoms were improved significantly after surgery. The patient did not want to have further treatment for the primary cancer, and she died from pneumonia caused by aggravation of the underlying disease 3 months after surgery. We report this rare case, which was diagnosed as a metastasis of a small cell lung cancer postoperatively, with a review of the relevant literature.