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Tahta A, Cetinkal A, Calis E, Dinc C. Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:334-339. [PMID: 36333089 DOI: 10.1016/j.neucie.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/25/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. CASE DESCRIPTION We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. CONCLUSION To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.
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Affiliation(s)
- Alican Tahta
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey.
| | - Ahmet Cetinkal
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Elif Calis
- Istanbul Medipol University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Cem Dinc
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
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Le Dû K, Alarion N, Rabi H, Casasnovas O, Robert P, Durand A, Burlet B, Tabouret-Viaud C, Ramla S, Martin L, Rossi C. Extranodal classical Hodgkin lymphoma involving the spinal cord: case report and review of the literature. CNS Oncol 2022; 11:CNS88. [PMID: 35694977 PMCID: PMC9280417 DOI: 10.2217/cns-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary CNS involvement is very rare in Hodgkin lymphoma. Here we present two cases of spinal cord dissemination. Two women of 40 and 65 years of age presented symptoms of spinal cord injury; imaging showed an intramedullary mass in T10 and T2, respectively, without vertebral involvement and upper diaphragmatic lymph nodes. Lymph-node biopsy confirmed the diagnosis of classical Hodgkin lymphoma in both patients. The first patient received four cycles of chemotherapy (escalated BEACOPP and ABVD) with intrathecal therapy, and the second four cycles of doxorubicin, vinblastine, dacarbazine (AVD) and local irradiation after surgery decompression. Complete metabolic response was obtained at the end of treatment. After 5 and 7 years of follow-up respectively, neurological deficits persisted in both. Lymph-node infiltration is the most common presentation in Hodgkin lymphoma at diagnosis. Primary extranodal involvement is rare and spinal cord infiltration exceptional. Back pain, tingling and vesico-sphincter dysfunctions are the main symptoms. 18F-fluorodeoxyglucose (FDG) PET and MRI can detect the location and extension of neurological involvement. We present here two cases of tumoral myelitis and a review of the literature. Local treatment (surgery/radiotherapy) is often administered together with chemotherapy to optimize local control and to avoid long-term sequelae.
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Affiliation(s)
- Katell Le Dû
- Department of Hematology, Confluent Private Hospital, Nantes, France
| | - Nicolas Alarion
- Nuclear Medecine, Institut Inter-RégionaL de Cancérologie Jean Bernard, Victor Hugo Medical Center, Le Mans, France
| | - Hassan Rabi
- Radiologic Department, Maine Image Santé, Le Mans, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Philippine Robert
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Amandine Durand
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Bénédicte Burlet
- INSERM UMR1231 UFR Bourgogne, Dijon, France.,Biology Department, University Hospital Center, Dijon, France
| | | | - Selim Ramla
- Department of Pathology, University Hospital Center, Dijon, France
| | - Laurent Martin
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Cédric Rossi
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
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Tahta A, Cetinkal A, Calis E, Dinc C. Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00046-4. [PMID: 33994284 DOI: 10.1016/j.neucir.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. CASE DESCRIPTION We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. CONCLUSION To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.
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Affiliation(s)
- Alican Tahta
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey.
| | - Ahmet Cetinkal
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Elif Calis
- Istanbul Medipol University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Cem Dinc
- Istanbul Medipol University, Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
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O'Neill AH, Phung TB, Lai LT. Intramedullary spinal cord metastasis from thyroid carcinoma: Case report and a systematic pooled analysis of the literature. J Clin Neurosci 2017; 49:7-15. [PMID: 29248379 DOI: 10.1016/j.jocn.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022]
Abstract
Intramedullary spinal cord metastasis (ISCM) is rare and occurs most commonly in the setting of advanced malignancy. The optimal management pathways are not well defined and treatment outcomes from contemporary therapies remain variable. We report a case of a 49-year-old woman with known primary papillary thyroid carcinoma, who presented with rapidly progressive clinical features of Brown-Sequard syndrome. A detailed pooled analysis of the literature was conducted to characterise the clinical and demographic features, management options, and expected survival outcomes for cases of ISCM. We secondarily performed a subgroup analysis on the incidence, clinical and management characteristics of thyroid carcinoma ISCM.
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Affiliation(s)
- Anthea H O'Neill
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Teik Beng Phung
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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Strickland BA, McCutcheon IE, Chakrabarti I, Rhines LD, Weinberg JS. The surgical treatment of metastatic spine tumors within the intramedullary compartment. J Neurosurg Spine 2017; 28:79-87. [PMID: 29125427 DOI: 10.3171/2017.5.spine161161] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Metastasis to the spinal cord is rare, and optimal management of this disease is unclear. The authors investigated this issue by analyzing the results of surgical treatment of spinal intramedullary metastasis (IM) at a major cancer center. METHODS The authors retrospectively reviewed the medical records of 13 patients who underwent surgery for IM. Patients had renal cell carcinoma (n = 4), breast carcinoma (n = 3), melanoma (n = 2), non-small cell lung cancer (n = 1), sarcoma (n = 1), adenoid cystic carcinoma (n = 1), and cervical cancer (n = 1). Cerebrospinal fluid was collected before surgery in 11 patients, and was negative for malignant cells, as was MRI of the neuraxis. Eleven patients presented with neurological function equivalent to Frankel Grade D. RESULTS Radiographic gross-total resection was achieved in 9 patients, and tumor eventually recurred locally in 3 of those 9 (33%). Leptomeningeal disease was diagnosed in 4 patients after surgery. In the immediate postoperative period, neurological function in 6 patients deteriorated to Frankel Grade C. At 2 months, only 2 patients remained at Grade C, 8 were at Grade D, and 1 had improved to Grade E. One patient developed postoperative hematoma resulting in Frankel Grade A. Radiotherapy was delivered in 8 patients postoperatively. The median survival after spine surgery was 6.5 months. Three patients are still living. CONCLUSIONS Surgery was performed as a last option to preserve neurological function in patients with IM. In most patients, neurological function returned during the immediate postoperative period and was preserved for the patients' remaining lifetime. The data suggest that surgery can be effective in preventing further decline in selected patients with progressive neurological deficit.
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Martinez DL, Gujrati M, Geoffroy F, Tsung AJ. Isolated CNS Hodgkin's lymphoma: implications for tissue diagnosis. CNS Oncol 2014; 3:383-7. [PMID: 25438809 PMCID: PMC6113894 DOI: 10.2217/cns.14.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CNS involvement in the setting of lymphoid neoplasia is a clinical situation that requires specific diagnosis due to the disparate treatment regimens recommended for neoplasms of specific lymphoid cell types. Cerebrospinal fluid (CSF) sampling may provide sufficient information to determine the presence of abnormal lymphoid cells but may not be able to further specify the malignant cellular population. In cases where abnormal clinical or radiographic features are present, accurate tissue diagnosis is essential. In this report, we define a rare case of primary CNS intramedullary Hodgkin's lymphoma without leptomeningeal dissemination diagnosed via resectional biopsy of a conus medullaris lesion. The patient received post-resection radiation therapy and subsequently demonstrated radiographic and clinical improvement. Lymphoid neoplasia within the CNS comprises a diverse group with varying response and survival rates. Treatment hinges upon accurate diagnosis as chemotherapy varies widely among Hodgkin's and non-Hodgkin's lymphoma. While CSF sampling may yield a positive result with sufficiency to diagnose an abnormal lymphoid cell population, tissue is necessary for further defining cellular pathology. In this report, we define a rare case of primary CNS intramedullary Hodgkin's lymphoma without leptomeningeal dissemination via resectional biopsy of a conus medullaris lesion. In cases where abnormal enhancement is found in eloquent CNS regions and lymphoid neoplasia is suspected, management often entails either stereotactic biopsy or CSF sampling. While CSF analysis may differentiate malignancy at a low rate, tissue diagnosis via paraffin block immunohistochemistry is necessary to further classify malignancy as primary or peripheral, Hodgkin's or non-Hodgkin's lymphoma, or other such as metastatic leptomeningeal dissemination and glioma. Within the subtypes of lymphoid neoplasms, treatment regimens vastly differ and thus accurate tissue diagnosis is paramount. We therefore present a rare case of primary CNS intramedullary Hodgkin's lymphoma without leptomeningeal disease in the setting of immunocompromise diagnosed via open resectional biopsy of the conus medullaris.
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Affiliation(s)
- Derek L Martinez
- Department of Neurosurgery/Neurosurgical Oncology, Illinois Neurological Institute/University of Illinois College of Medicine, 530 NE Glen Oak, Peoria, IL 61637, USA
| | - Meena Gujrati
- Department of Neuropathology, Illinois Neurological Institute/University of Illinois College of Medicine, 530 NE Glen Oak, Peoria, IL 61637, USA
| | - Francois Geoffroy
- Department of Neuro-oncology, Illinois Cancer Care, 8940 N Wood Sage Road, Peoria, IL 61615, USA
| | - Andrew J Tsung
- Department of Neurosurgery/Neurosurgical Oncology, Illinois Neurological Institute/University of Illinois College of Medicine, 530 NE Glen Oak, Peoria, IL 61637, USA
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Hodgkin's Lymphoma: A Review of Neurologic Complications. Adv Hematol 2010; 2011:624578. [PMID: 20975772 PMCID: PMC2957132 DOI: 10.1155/2011/624578] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 08/26/2010] [Indexed: 12/18/2022] Open
Abstract
Hodgkin's lymphoma is a hematolymphoid neoplasm, primarily of B cell lineage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications of Hodgkin's Lymphoma can be separated into those that result directly from the disease, indirectly from the disease, or from its treatment. Direct neurologic dysfunction from Hodgkin's Lymphoma results from metastatic intracranial spinal disease, epidural metastases causing spinal cord/cauda equina compression, leptomeningeal metastases, or intradural intramedullary spinal cord metastases. Indirect neurologic dysfunction may be caused by paraneoplastic disorders (such as paraneoplastic cerebellar degeneration or limbic encephalitis) and primary angiitis of the central nervous system. Hodgkin's lymphoma treatment typically includes chemotherapy or radiotherapy with potential treatment-related complications affecting the nervous system. Neurologic complications resulting from mantle-field radiotherapy include the “dropped head syndrome,” acute brachial plexopathy, and transient ischemic attacks/cerebral infarcts. Chemotherapy for Hodgkin's lymphoma may cause cerebral infarction (due to emboli from anthracycline-induced cardiomyopathy) and peripheral neuropathy.
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Intradural intramedullary spinal cord metastasis due to mesothelioma. J Neurooncol 2009; 97:133-6. [PMID: 19693437 DOI: 10.1007/s11060-009-9995-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED To report the occurrence of intramedullary spinal cord metastases in a patient with a mesothelioma. A case report. SETTING University medical center. A 67-year old man with mesothelioma developed paraparesis 6-months after diagnostic thoracotomy. MR spine imaging revealed an intramedullary spinal cord metastases. Cyberknife radiotherapy. Intramedullary spinal cord metastases, although rare, is increasingly recognized with spinal cord MRI. Treatment remains unsatisfactory as treatment with surgery or irradiation is only partially effective.
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9
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Heran NS, Yong RL, Heran MS, Yip S, Fairholm D. Primary intradural extraarachnoid hodgkin lymphoma of the cervical spine. Case report. J Neurosurg Spine 2006; 5:61-4. [PMID: 16850958 DOI: 10.3171/spi.2006.5.1.61] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 42-year-old man presented with an intradural extramedullary mass in his lower cervical spine. On imaging studies the lesion mimicked the appearance of a meningioma. At surgery, the mass was found to be an intradural extra-arachnoid tumor. An intraoperative pathological examination determined the lesion to be a Hodgkin lymphoma. The procedure was limited to biopsy sampling and the patient was treated further with adriamycin, bleomycin, vincristine, and dacarbazine chemotherapy, after which remission was demonstrated both clinically and on images. Analysis of a frozen section obtained during the procedure aided in the diagnosis of the tumor, thus preventing further resection and the potential neurological complications associated with more radical resection. To the authors' knowledge this is the first reported case of a presumed primary intradural extraarachnoid Hodgkin lymphoma.
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Affiliation(s)
- Navraj S Heran
- Division of Neurosurgery, Fraser Health Authority, New Westminster, British Columbia, Canada
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10
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Kaya RA, Dalkiliç T, Ozer F, Aydin Y. Intramedullary Spinal Cord Metastasis: A Rare and Devastating Complication of Cancer -Two Case Reports-. Neurol Med Chir (Tokyo) 2003; 43:612-5. [PMID: 14723269 DOI: 10.2176/nmc.43.612] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two cases of very rare intramedullary spinal cord metastasis from colon carcinoma and renal carcinoma were treated primarily by microsurgical excision. A 44-year-old female presented with colon carcinoma metastasis manifesting as complete neurological deficit. She had undergone colon resection 2 years previously for colon carcinoma. The tumor was excised by microsurgery with megadose steroid therapy but she remained paraplegic. A 43-year-old man presented with renal carcinoma metastasis manifesting as incomplete neurological deficits. He had undergone nephrectomy one year previously for renal carcinoma. The tumor was removed by microsurgery. He made a remarkable neurological recovery and became ambulatory after physical therapy.
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Affiliation(s)
- R Alper Kaya
- Department of Neurosurgery, Sişli Etfal Hospital, Istanbul, Turkey.
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11
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Guermazi A, Brice P, de Kerviler E E, Fermé C, Hennequin C, Meignin V, Frija J. Extranodal Hodgkin disease: spectrum of disease. Radiographics 2001; 21:161-79. [PMID: 11158651 DOI: 10.1148/radiographics.21.1.g01ja02161] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extranodal lesions in Hodgkin disease may develop and spread to virtually any organ system, simulating other neoplastic or infectious diseases. It is important to determine whether extranodal involvement represents a primary manifestation or dissemination of systemic disease, which has a poorer prognosis. Computed tomography (CT) is the preferred modality, although ultrasonography and magnetic resonance (MR) imaging may also be helpful. CT is superior to conventional radiography in assessing chest disease, although MR imaging is more sensitive than CT in detecting chest wall involvement. CT is preferred for evaluating hepatic lymphoma and has proved particularly valuable in diagnosing gastric lymphoma and detecting renal or perirenal masses. CT and MR imaging are equally effective in detecting brain Hodgkin disease; however, the latter is superior in the detection of extracerebral tumor deposits in the subdural or epidural space. MR imaging is also preferred for evaluating meningeal and spinal cord involvement. Both MR imaging and CT allow excellent assessment of bone texture and accurate analysis of tumoral bone invasion, but MR imaging is superior in demonstrating bone marrow infiltration, and CT is superior in delineating the extent of cortical bone destruction. In the future, metabolic positron emission tomography may provide more information about extranodal lymphoma than do the current imaging modalities.
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Affiliation(s)
- A Guermazi
- Department of Radiology, Saint-Louis Hospital, AP-HP, 1 Avenue Claude Vellefaux, 75475 Paris, France.
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Schijns OE, Kurt E, Wessels P, Luijckx GJ, Beuls EA. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000; 102:249-254. [PMID: 11154816 DOI: 10.1016/s0303-8467(00)00106-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors report the case of a 70-year-old woman who developed a Brown-Sequard-syndrome within 6 weeks caused by an intramedullary spinal cord metastasis of an occult renal cell carcinoma. Intramedullary metastases are rare and represent only 4-8.5% of central nervous system metastases. An important feature of intramedullary metastases is the rapid progression of neurological deficits which necessitates rapid treatment. There are only eight earlier reports of intramedullary metastasis due to renal cell carcinoma (Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 1996;47:906-12; Belz P. Ein Fall von intramedullaerer Grawitz-Metastase im Lumbalmark. Frankfurt Z Pathol 1912;10:431-44; Gaylor JB, Howie JW. Brown-Sequard-syndrome. A case of unusual aetiology. J Neurol Neurosurg Psychiatry 1938;1:301-5; Kawakami Y, Mair WGP. Haematomyelia due to secondary renal carcinoma. Acta Neuro Pathol 1973;26:85-92; Strang RR. Metastatic tumor of the cervical spinal cord. Med J Aust 1962;1:205-6; Von Pfungen. Uber einige Fälle von Haematomyelie nichttraumatischen Ursprungs. Wien Klin Rdsch 1906;20:44-50; Weitzner S. Coexistent intramedullary metastasis and syringomyelia of cervical spinal cord. Report of a case. Neurology 1960;674-8). To the best of our knowledge this is the first report on a patient in whom symptoms from the metastasis of a renal cell carcinoma preceded the detection of the primary tumor. This report presents the clinical, neuroradiological and histopathological findings of an intramedullary metastasis of a renal cell carcinoma and provides an overview of the literature on intramedullary spinal cord metastases.
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Affiliation(s)
- O E Schijns
- Department of Neurosurgery, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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13
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Jardin F, Stamatoullas A, Fruchart C, D'Anjou J, Clément JF, Tilly H. [Intramedullary spinal cord metastasis and leptomeningeal involvement in Hodgkin's disease. Case report and review of the literature]. Rev Med Interne 1999; 20:267-71. [PMID: 10216885 DOI: 10.1016/s0248-8663(99)83056-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Central nervous system, especially spinal cord involvement, is unusual in Hodgkin's disease. We report the case of a patient with refractory Hodgkin's disease who presented with intramedullary involvement. EXEGESIS A 36-year-old woman presented with weakness of the right lower extremity and sphincter dysfunction 13 years after initial diagnosis of Hodgkin's disease. Magnetic resonance imaging showed intraspinal tumor with contrast enhancement extending from C7 to D1. Cerebrospinal fluid examination revealed the presence of Reed-Sternberg cells. Specific intramedullary spinal cord metastasis and leptomeningeal involvement were confirmed. Despite intrathecal chemotherapy the neurologic deficit progressed to paraplegia and the patient died 2 months later. CONCLUSION Intramedullary spinal cord metastases rarely occur in the course of Hodgkin's disease. Except for the initial presentation, their prognosis is poor despite early diagnosis with magnetic resonance imaging. Other causes such as epidural cord compression, paraneoplasic myelopathy, granulomatous angiitis and radiation myelopathy are still delated.
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Affiliation(s)
- F Jardin
- Service d'hématologie, centre de lutte contre le cancer Henri-Becquerel, Rouen, France
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14
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Okamoto H, Shinkai T, Matsuno Y, Saijo N. Intradural parenchymal involvement in the spinal subarachnoid space associated with primary lung cancer. Cancer 1993; 72:2583-8. [PMID: 8402479 DOI: 10.1002/1097-0142(19931101)72:9<2583::aid-cncr2820720912>3.0.co;2-k] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Intradural parenchymal involvement (IPI) in the spinal subarachnoid space associated with primary lung cancer is rare. A retrospective study was undertaken to investigate the clinical and pathologic features of IPI. METHOD A total of 1215 cases of primary lung cancer were studied at autopsy; the results were reviewed retrospectively. RESULTS Twenty (1.65%) of the cases revealed IPI in the spinal subarachnoid space. The histologic diagnoses were small cell carcinoma in ten cases, adenocarcinoma in eight cases, and squamous cell carcinoma in two cases. In 14 (70%) cases, the IPI was located between the lumbar and cauda equina of the spinal cord. However, no metastases were observed in the cervical spinal cord. Brain metastasis, vertebral metastasis, and meningeal carcinomatosis were seen in 70%, 60%, and 40% of the 20 cases, respectively, suggesting that these metastases may be related to the metastatic pathway to the spinal cord. Most patients had neurologic symptoms or signs referable to IPI; IPI could be diagnosed before death in only one patient by magnetic resonance imaging. The median interval between diagnosis of lung cancer and development of IPI and median survival after the onset of neurologic symptoms referable to IPI were 415 days and 110 days, respectively. CONCLUSION The authors retrospectively received 1215 autopsies of patients with primary lung cancer and found 20 (1.65%) with IPI.
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Affiliation(s)
- H Okamoto
- Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
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