Medullary Metastases Research Articles

Understanding metastatic involvement of the conus medullaris: a systematic review of clinical presentations, diagnostic approaches, treatment options, and patient outcomes.

Metastasis to the conus medullaris (CM) is a rare but devastating condition. This systematic review aimed to evaluate the clinical presentation, diagnostic workup, treatment options, and outcomes of patients with CM metastasis. By synthesizing the available evidence, this study seeks to improve our understanding of this condition and inform clinical practice. A systematic review adhering to PRISMA guidelines analyzed literature on CM metastasis from 1997 to January 2024. Human studies in English were included, focusing on primary research articles. Screening criteria ensured a homogeneous study population, with data analyzed using SPSS 26 and assessed for quality using the JBI checklist. The study analyzed 88 patients with conus medullaris metastasis. Common symptoms included back pain (49.3%), sensory impairment (75%), and bladder dysfunction (60.3%). MRI was the primary diagnostic tool, revealing lesions above L1 (37%) or between L1 and L2 (29%). Treatment involved surgery with laminectomy, and combined therapy (surgery plus radiotherapy) in 81.3%. Postoperative outcomes showed improved motor function in 59.6% of patients, while combined therapy yielded better sensory and bowel/bladder function recovery. Median survival was 100 days. Metastasis to the conus medullaris is rare but significant. Surgical resection can improve motor function, while combined therapy (surgery plus radiotherapy) is effective in improving sensory manifestations and bowel/bladder functions. Despite these treatments, the median survival remains around 100 days, which is shorter compared to other types of intramedullary spinal cord metastases.

Conus Medullaris Metastasis in a Patient with Triple-positive Breast Cancer

Conus Medullaris Metastasis in a Patient with Triple-positive Breast Cancer

Follow up of Medulloblastoma’s Treatment Retrospective Study of 144 Cases

Introduction: Medulloblastoma is the most common childhood primary CNS tumor, and treatment approaches have evolved over the past three decades. Despite recent improvements in cure rates, prediction of disease outcome remains a major challenge and survivors suffer from serious therapy-related side-effects. Patients and Methods: A retrospective study including 144 patients with medulloblastoma were performed at the Neurosurgery Department in Ait IDDIR Health Hospital Establishment between The period of January 2004 and December 2014. In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically. All patients were operated and received the adjuvant treatment Results and discussion: Out of 144 patients, 63 (44%) patients were females and 81 (56%) were males. We have 59 cases who had age ranged from 05 months to 5 years, however, we had 85 cases who had more than 5 years; we identified 29 (58%) children and 21 (42%) adults. Clinical manifestations of meduloblastoma vary widely according to the location. The vermis is the main location of the child with 95%. The most frequent clinical manifestations found were Intracranial hypertension syndrome and static and kinetic cerebellar syndrome, 98% patients had intracranial hypertension at diagnosis: 1,4% with engagement (2 cases) and 0,7% with coma(01 case). A ventriculo-peritoneal shunt was performed in all patients, 01 case after surgical removal. The most common complications were as follows: Meningitis ( 0,2%),ventriculitis (0,2%), CSF leakage (0,4%), post-surgical hematoma (0,2%), Shunt dysfunction ( 0,6%), aggravation of the cerebellar syndrom (0,4%), affection of mixed nerves ( 0,2%) and cerebellar mutism (0,4%). Tumor architecture was classified as classic (Grade II) and desmoplasic. We had T2M0 in 41(28,47%) cases, T2M2 in 2 (1,38%)cases ,T3aM0 in 98(68%)cases,T3bM3 in 2(1,38%) cases and T3bM4 in 1 (0,7%)case. During follow-up period, recurrence occurred in 15 (10%) cases, sustentorial metastasis in 04 (2,7%) cases, leptomeningeal dissemination in 03 (2%) cases and medullary metastasis in 03 (2%) cases. The five years survival rate was 84%. Conclusion: the surgical treatment of medulloblastoma remains a difficult therapeutic challenge because they have the most virulent form of the disease and are at highest risk for treatment-related sequelae.

5-Aminolevulinic acid fluorescence-guided surgery for spinal cord melanoma metastasis: a technical note.

According to our research, just few studies described 5-Aminolevulinic acid (5-ALA) use for spinal injuries resection. 5-ALA is known to be especially useful in certain spinal tumor entities such as meningiomas, ependymomas, hemangiopericytomas, and metastasis of central nervous system primary tumors. In contrast, 5-ALA has limited value in other histopathological tumoral entities, as neurinomas and carcinoma metastasis. We describe a microsurgical resection of a spinal cord melanoma through fluorescence-guided technique using 5-ALA in a 36-year-old man. Strong 5-ALA tumor enhancement was evidenced, resulting in gross-total resection. To our knowledge, this is the first case of nonglial intramedullary metastasis with 5-ALA positive staining. We believe that this tool, 5-ALA, could aid in the resection, identification, and differentiation of medullary metastasis.

Malignant pheochromocytoma and neurofibromatosis type 1

Introduction Compared to normal population, patients with neurofibromatosis are at higher risk for the development of benign and malignant tumors. Pheochromocytomas are relatively rare in neurofibromatosis type 1 (NF1), and malignant ones are even rarer. Aim of the presentation Our aim was to report a malignant pheochromocytoma with multiple bone and medullary metastases in a patient with NF1. Case report A female patient aged 24 years old, whose father had a colonic cancer, consulted for abdominal pain and vomiting. Her clinical examination pleaded for NF 1 (multiple “cafe-au-lait” spots, and freckles in the underarms) without high blood pressure or other features. Radiological assessment discovered a right heterogeneous adrenal tumor measuring 6 cm. Biochemical exploration showed normal urinary catecholamines, but MIBG scintigraphy pleaded for unilateral pheochromocytoma. A rapid work up for possible associations and metastases was negative. She was operated on and histological examination confirmed the diagnosis of pheochromocytoma with a Pass score of 4%. After surgery, although the adrenals were free of tumor, urinary catecholamines were very high and there were diffuse bone and medullary metastases with MIBG uptake. Chemotherapy and MIBG treatment are being considered. Conclusion The association of a malignant pheochromocytoma with neurofibromatosis type 1 although very rare should be known as pheochromocytoma and its metastases may be totally asymptomatic as in the presented case.

Medullary metastasis of a malignant peripheral nerve sheath tumor: A case report

The present study reports a case of medullary metastasis without lung metastasis that occurred as a result of a malignant peripheral nerve sheath tumor (MPNST). An 81-year-old woman presented with a MPNST in the left brachial plexus, arising from the cervical nerve root. The patient underwent carbon ion radiotherapy; however, tumor recurrence was identified in the left shoulder. Subsequently, the patient underwent wide excision. Three weeks subsequent to surgery, imbalance and dysarthria developed suddenly. Dysphagia emerged and left upper limb pain disappeared on the day after symptom development. Magnetic resonance imaging (MRI) revealed that this was due to metastasis to the medulla. Five days subsequent to the onset of dysarthria, the patient succumbed due to respiratory failure. To the best of our knowledge, no previous cases of medullary metastasis arising from a MPNST in the absence of lung metastasis have been reported. MRI is a useful examination tool for the identification of brain metastases; however, the high cost of MRI as a routine examination must be considered due to the rarity of brain metastases. Therefore, methods to detect brain metastasis warrant further investigation.

Intramedullary conus medullaris metastasis from prostate carcinoma: A case report and review of the literature

Intramedullary spinal cord metastases (ISCMs) are rare and account for 4–8.5% of central nervous system metastases. Only one case of biopsy-proven ISCM due to prostate cancer has previously been reported. The current study presents an additional unique case of a 74-year-old male who developed symptoms from an intramedullary conus medullaris metastasis as the first manifestation of prostate adenocarcinoma. To the best of our knowledge, this scenario is even more rare and has not previously been reported. The tumor was radically resected, followed by androgen blockade treatment. The patient’s neurological deficit significantly improved, with no tumor recurrence during the follow-up period. In addition, the present study provides an overview of the previous literature concerning ISCMs from prostate cancer, and discusses the treatment options.

Drop Metastasis Seeding the Intramedullary Conus Medullaris in a Patient with Breast Cancer and Brain Metastasis

Breast cancer metastasis to the conus medullaris is very rare. We report a case of intra-axial conus medullaris metastasis from breast adenocarcinoma in a 39-years-old woman. Two years after the diagnosis of brain metastasis was biopsy-proven, she developed progressive lower limb weakness with urinary incontinence for one month. MRI revealed a contrast-enhancing intramedullary lesion at the conus medullaris. Laminectomy and removal of the tumor were performed for decompression and for preserving function. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. We discuss the possibility of drop metastasis traveling from the brain to the conus medullaris via cerebrospinal fluid (CSF) in the central canal. Since intramedullary spinal cord metastasis can lead to rapid progressive neurological deficits and poor outcome, early diagnosis and decompression could preserve the quality of life. We suggest that CSF cytology could be helpful for the diagnosis of intraspinal metastasis in patients with brain metastasis.

Drop Metastasis Seeding the Intramedullary Conus Medullaris in a Patient with Breast Cancer and Brain Metastasis

Breast cancer metastasis to the conus medullaris is very rare. We report a case of intra-axial conus medullaris metastasis from breast adenocarcinoma in a 39-year-old woman. Two years after the diagnosis of brain metastasis was biopsy-proven, she developed progressive lower limb weakness with urinary incontinence for one month. MRI revealed a contrast-enhancing intramedullary lesion at the conus medullaris. Laminectomy and removal of the tumor were performed for decompression and for preserving function. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. We discuss the possibility of drop metastasis traveling from the brain to the conus medullaris via cerebrospinal fluid (CSF) in the central canal. Since intramedullary spinal cord metastasis can lead to rapid progressive neurological deficits and poor outcome, early diagnosis and decompression could preserve the quality of life. We suggest that CSF cytology could be helpful for the diagnosis of intraspinal metastasis in patients with brain metastasis.

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 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.

Paraplegie revelant un lymphome malin non hodgkinien chez l’adulte a propos d’un cas et revue de la litterature.

We return the observation of a man of 66 years to the antecedents of diabetes non insulinodependant and arterial high blood pressure that presented a paraplegia as revealing symptom of a LMNH. It is here about an initial localization of the lymphoma to the spine. The international literature shows an extreme rarity of the affection. To the total 67 cases have been returned only in the world since 1970 of which 18 observations since 2000. Our observation constitutes the first added on case in the African literature. The compressive diagnosis has been put thanks to the scanner whereas in the literature, the IRM was the most adapted exam. The observation of an elevation ten times superior to the normal of the specific antigens of the prostate had driven in a first time to the hypothesis of medullary metastases of a cancer of the prostate. The instituted specific treatment was without success. The neurochirurgical intervention in Benin then the exam of the tumorous mass to the hinge dorsolombaire and the anatomopathologic exam of the biopsy piece to have the diagnosis of LMNH.

PET/CT Imaging of Conus Medullaris Metastasis From Lung Cancer

An intradural extramedullary metastasis is usually detected at an advanced stage of the disease or during workup for manifestations of spinal cord compression. Early diagnosis of such a lesion is rare and mostly fortuitous. The authors present a case of treated nonsmall cell lung carcinoma with an asymptomatic conus medullaris metastasis, which was demonstrated by PET/CT imaging during restaging evaluation.

Imagerie des complications neurologiques du carcinome bronchique

The natural history of bronchogenic carcinoma shows that 42% of patients are diagnosed with cancer-related neurological complications either at initial presentation or at follow-up that can be separated in 3 different categories: — locoregional involvement of cervicothoracic nerves (recurrent laryngeal nerves, phrenic and vagus nerves, brachial plexus and sympathetic cervical chains), — metastatic disease characterized by intracranial lesions (brain, meningeal, ependymal and pituitary metastases) and spinal (extradural, subarachnoid and medullary metastases) lesions, — paraneoplastic syndromes including limbic encephalitis, Lambert-Eaton syndrome and paraneoplastic cerebellar degeneration. These neurological disorders usually are associated with advanced cancer for which radical surgical management seldom is indicated. All imaging studies performed at the time of initial staging for bronchogenic carcinoma should therefore be carefully reviewed in order to detect signs that could suggest the presence of one or several neurological complications. The goals of this paper are to describe the clinical signs and to illustrate the imaging features of neurological complications related to bronchogenic carcinoma at conventional radiography, CT and MRI.