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Dai L, Zou MJ, Liao RL, Zhang BR, Ma ZQ, Liu MW. Primary intraspinal neuroendocrine tumor: A case report and literature review. Medicine (Baltimore) 2024; 103:e39196. [PMID: 39121254 PMCID: PMC11315503 DOI: 10.1097/md.0000000000039196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/16/2024] [Indexed: 08/11/2024] Open
Abstract
RATIONALE Neuroendocrine tumors (NET) refer to a group of uncommon tumors arising in the neuroendocrine system. Most NETs occur in the digestive tract and bronchi but are rare in the central nervous system, especially in the spinal canal. NET in the central nervous system mainly metastasize from other systems, with non-specific clinical symptoms. In this study, we report the diagnosis and treatment of intraspinal NET to provide clinical guidance as well as to avoid misdiagnosis and missed diagnosis. PATIENT CONCERNS A 59-year-old male patient, presented with recurrent right lower limb pain for half a year, accompanied by numbness and weakness for 4 months and aggravation for 2 months. Lumbar spine magnetic resonance imaging (MRI) revealed a space-occupying lesion in the spinal canal. The diagnosis of primary intraspinal NET was confirmed by topathological examination. DIAGNOSIS Primary intraspinal NET tumor. INTERVENTIONS Surgical resection. OUTCOMES Significant improvements in right lower limb pain, numbness, and weakness were observed, and lumbar spine MRI was performed again to dynamically observe the changes in intraspinal NET. CONCLUSIONS Surgical resection may be an effective treatment for intraspinal NETs. LESSONS Intraspinal NETs are relatively rare and mostly manifest as limb numbness, weakness, and pain. Due to its nonspecific clinical symptoms, intraspinal NETs are easily misdiagnosed as lumbar disc herniation with radiculopathy and lumbar spondylolisthesis. Therefore, in patients with long-term symptoms, in addition to common lumbar neuromuscular diseases, lumbar MRI should be performed promptly to exclude the possibility of lumbar NETs.
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Affiliation(s)
- Li Dai
- Department of Endocrinology, The Second People’s Hospital of Jiangjin District, Chongqing, China
| | - Ming-Ju Zou
- Department of Endocrinology, The Second People’s Hospital of Jiangjin District, Chongqing, China
| | - Ren-Li Liao
- Department of Orthopedics, People’s Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China
| | - Bing-Ran Zhang
- Department of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Qiang Ma
- Department of Clinical Laboratory, People’s Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China
| | - Ming-Wei Liu
- Department of Emergency, People’s Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China
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2
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Pagano A, Iaquinandi A, Fraioli MF, Bossone G, Carra N, Salvati M. Cauda equina syndrome from intradural metastasis of a non-neural tumor: case report and review of literature. Br J Neurosurg 2023; 37:1487-1494. [PMID: 34330176 DOI: 10.1080/02688697.2021.1958155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cauda equina syndrome (CES) is a challenging condition and it can be caused by variable entities. Leptomeningeal carcinomatosis (LC) is a multifocal seeding of the leptomeninges by malignant cells and it is observed in 1-8% of patients with solid tumors. Diagnosis of intradural metastases of the cauda equina is often delayed due to the non-specific characteristics of this condition but also to the delay of presentation of many patients. Cauda equina metastases usually occur in advanced cancers, but rarely can be the first presentation of disease. CASE DESCRIPTION A 63-year-old man presented with 6 months history of low back pain and 20 d history of bilateral sciatica, hypoesthesia of the legs and the saddle, flaccid paraparesis and bowel incontinence determine by multiple nodular small lesions on the entire cauda equina with contrast-enhancement. Total-body CT showed a millimetric lesion at the lung. The patient underwent L2-L5 laminectomy and subtotal removal and histological examination showed a small cell lung carcinoma metastasis. CONCLUSIONS In the literature, 54 cases of CES from non-CNS tumor metastasis are described. The diagnosis is challenging, back pain, with or without irradiation to the lower limbs, is the most frequently reported disturbance. In about 30% of patients there is no known malignancy and CES is the first clinical presentation. Treatment of choice is surgery, followed by radiotherapy and less frequently adjuvant chemotherapy. The surgical removal is almost always incomplete and functional outcome is often not satisfactory. Prognosis is poor.
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Affiliation(s)
- Andrea Pagano
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | - Andrea Iaquinandi
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | - Mario Francesco Fraioli
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | | | | | - Murizio Salvati
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
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3
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Apostolidis L, Schrader J, Jann H, Rinke A, Krug S. Leptomeningeal Carcinomatosis: A Clinical Dilemma in Neuroendocrine Neoplasms. BIOLOGY 2021; 10:biology10040277. [PMID: 33800581 PMCID: PMC8066280 DOI: 10.3390/biology10040277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS) involvement by paraneoplastic syndromes, brain metastases, or leptomeningeal carcinomatosis (LC) in patients with neuroendocrine neoplasms (NEN) has only been described in individual case reports. We evaluated patients with LC in four neuroendocrine tumor (NET) centers (Halle/Saale, Hamburg, Heidelberg, and Marburg) and characterized them clinically. In the study, 17 patients with a LC were defined with respect to diagnosis, clinic, and therapy. The prognosis of a LC is very poor, with 10 months in median overall survival (mOS). This is reflected by an even worse course in neuroendocrine carcinoma (NEC) G3 Ki-67 >55%, with a mOS of 2 months. Motor and sensory deficits together with vigilance abnormalities were common symptoms. In most cases, targeted radiation or temozolomide therapy was used against the LC. LC appears to be similarly devastating to brain metastases in NEN patients. Therefore, the indication for CNS imaging should be discussed in certain cases.
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Affiliation(s)
- Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Jörg Schrader
- I. Medical Department—Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Henning Jann
- Department of Gastroenterology and Hepatology, Charité—University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, University Hospital Marburg, Baldinger Strasse, 35043 Marburg, Germany
- Correspondence: (A.R.); (S.K.); Tel.: +49-0345-557-2661 (S.K.); Fax: +49-0345-557-2253 (S.K.)
| | - Sebastian Krug
- Clinic for Internal Medicine I, Martin-Luther University Halle/Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany
- Correspondence: (A.R.); (S.K.); Tel.: +49-0345-557-2661 (S.K.); Fax: +49-0345-557-2253 (S.K.)
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Nicoletti GF, Umana GE, Graziano F, Calì A, Fricia M, Cicero S, Scalia G. Cauda equina syndrome caused by lumbar leptomeningeal metastases from lung adenocarcinoma mimicking a schwannoma. Surg Neurol Int 2020; 11:225. [PMID: 32874728 PMCID: PMC7451188 DOI: 10.25259/sni_365_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Cauda equina syndromes (CESs) due to leptomeningeal metastases from primitive lung tumors are rare. Despite recent advancements in neuro-oncology and molecular biology, the prognosis for these patients remains poor. Here, we present a case in which a patient developed lumbar leptomeningeal metastases from lung carcinoma that contributed to a CES and reviewed the appropriate literature. Case Description: A 55-year-old female presented with the left lower extremity sciatica/weakness. Two years ago, a then 53-year-old female had received Gamma Knife stereotactic radiosurgery (SRS) for a cerebellopontine angle schwannoma. Recently, she underwent resection of lung carcinoma and SRS for a right hemispheric cerebellar metastasis. Now at age 55, she presented with the left lower extremity sciatica/weakness. When her new lumbar MR was interpreted as showing a L5 schwannoma, a L4-L5 laminectomy was performed at surgery, the authors encountered multifocal leptomeningeal metastases densely infiltrating the cauda equina. Although only subtotal resection/decompression of tumor was feasible, she did well for the ensuing year. The histological diagnosis confirmed the lesion to be a poorly differentiated lung adenocarcinoma. Conclusion: Patients with a history of prior metastatic lung cancer may present with spinal leptomeningeal metastases resulting in a CES.
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Affiliation(s)
- Giovanni Federico Nicoletti
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Piazza Santa Maria di Gesù 5, Catania, Italy
| | | | - Francesca Graziano
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Piazza Santa Maria di Gesù 5, Catania, Italy
| | - Alessandro Calì
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Piazza Santa Maria di Gesù 5, Catania, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Via Messina 829, Catania, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Cannizzaro Hospital, Via Messina 829, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Piazza Santa Maria di Gesù 5, Catania, Italy
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5
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Armstrong V, Schoen N, Madhavan K, Vanni S. A systematic review of interventions and outcomes in lung cancer metastases to the spine. J Clin Neurosci 2019; 62:66-71. [PMID: 30655233 DOI: 10.1016/j.jocn.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/01/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
Seventy percent of cancer patients will have metastatic bone disease, most commonly in the vertebra. Prognosis of metastatic lung cancer is poor and treatment is mostly palliative. To-date, there is no systematic review on the ideal treatment for lung cancer with spinal metastases in regards to mortality. Literature searches were performed based on PRISMA guidelines for systematic review. Thirty-nine studies comprising 1925 patients treated for spinal metastases of lung cancer met inclusion criteria. All analyses were performed using SAS and SPSS. Data were analyzed for meaningful comparisons of baseline patient characteristics, primary cancer type, metastatic lesion characteristics, treatment modality, and clinical and radiologic outcomes. Significantly greater mean survival length was seen in the non-surgical group (8.5 months, SD 6.6, SEM 0.17) compared to the surgical group (7.5 months, SD 4.5, SEM 0.25; p = 0.013). There was no statistically significant survival difference between different types of primary lung cancer: NSCLC (8.3 months, SD 13.8, SEM 0.91) and SCLC (7.0 months, SD 4.6, SEM 0.46; p = 0.36). Number of vertebral levels involved per lesion also did not exhibit significant difference: single lesion (11.3 months, SD 6.8, SEM 2.2) and multiple lesions (13.8 months, SD 15.7, SEM 3.6; p = 0.64). For patients with symptomatic spinal metastases from lung cancer, non-operative approaches experience significantly better survival outcomes (p = 0.013). Future clinical studies are needed to determine the best treatment algorithm to help maximize outcomes and minimize mortality in metastatic lung cancer.
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Affiliation(s)
- V Armstrong
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - N Schoen
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - K Madhavan
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Vanni
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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6
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Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X. Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: a case report and review of literature. Onco Targets Ther 2018; 11:5009-5013. [PMID: 30174438 PMCID: PMC6109657 DOI: 10.2147/ott.s165299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cauda equine syndrome (CES) is a neurological condition caused by compression of the cauda equine. Here, we demonstrate a case of CES as the primary symptom of leptomeningeal metastases from non-small cell lung carcinoma without brain metastases. A 59-year-old male suffered progressive lower extremity motor dysfunction, urinary dysfunction, and lower extremity sensory dysfunction. He was clinically diagnosed with CES. Nuclear magnetic resonance imaging demonstrated several vague nodules in the area of conus medullaris and cauda equine, without lumbar or thoracic herniated discs. The serum carcinoembryonic antigen concentration was 191.20 ng/mL. The conclusion following positron emission tomography–computed tomography was a right upper lung malignant tumor with mediastinal lymph node metastasis and cauda equina metastasis. Pathologic diagnosis was of primary adenocarcinoma of the lung by bronchoscopic biopsy. EML4–ALK fusion and EGFR mutations were absent, and thus the patient received chemotherapy. However, symptoms of intracranial hypertension arose 1 month later, and the patient died 3 months postadmission. Emerging CES may be a sign of metastasis of a malignant tumor, presenting an extremely challenging condition, especially for patients with lung cancer. Positron emission tomography–computed tomography is a fairly effective technique to make the diagnosis.
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Affiliation(s)
- Yang Liu
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Dongmei Di
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Min Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China,
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7
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Yang G, Pan Z, Ma N, Qu L, Yuan T, Pang X, Yang X, Dong L, Liu S. Leptomeningeal metastasis of pulmonary large-cell neuroendocrine carcinoma: A case report and review of the literature. Oncol Lett 2017; 14:4282-4286. [PMID: 28943940 DOI: 10.3892/ol.2017.6676] [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: 05/06/2016] [Accepted: 06/02/2017] [Indexed: 12/20/2022] Open
Abstract
Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a rare and malignant form of lung cancer with a poor prognosis for patients. The common sites of metastases are the liver, adrenal glands, bone and brain. LCNEC rarely metastasizes to the small intestine, ovaries, tonsils, mandible, vulva or spine. To the best of our knowledge, there have been no reports of leptomeningeal metastasis of LCNEC to date. The present case report describes an unusual case of leptomeningeal metastasis from pulmonary LCNEC alongside a review of the literature. Biopsies of pulmonary lesions and cervical lymph nodes confirmed the diagnosis of LCNEC in a 39-year-old male patient. At 2 months after chemotherapy, the patient began to experience hoarseness, epileptic seizures and blurred vision. Furthermore, the patient presented with radiating pain and numbness in his lower left limb. Imaging findings and cytological examination of cerebral spinal fluid supported the diagnosis of leptomeningeal metastasis. The patient's neurological symptoms were markedly alleviated following receipt of radiation and intrathecal chemotherapy. The patient survived for 4.9 months after diagnosis with leptomeningeal metastasis. To the best of our knowledge, the present case report is the first to describe leptomeningeal metastasis from pulmonary LCNEC confirmed by neuroimaging and cerebral spinal fluid cytology. It suggests that leptomeningeal metastasis does occur in this rare disease, and aggressive treatment may result in improved symptoms and possibly survival times.
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Affiliation(s)
- Guozi Yang
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhenyu Pan
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ning Ma
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Tingting Yuan
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaochuan Pang
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xu Yang
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lihua Dong
- Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shixin Liu
- Department of Radiation-Oncology, Tumor Hospital of Jilin, Changchun, Jilin 130000, P.R. China
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8
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Papa A, Rossi L, Verrico M, Di Cristofano C, Moretti V, Strudel M, Zoratto F, Minozzi M, Tomao S. Breast metastasis and lung large-cell neuroendocrine carcinoma: first clinical observation. CLINICAL RESPIRATORY JOURNAL 2015; 11:574-578. [PMID: 26365150 DOI: 10.1111/crj.12385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/09/2015] [Accepted: 09/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The lung large-cell neuroendocrine carcinoma (LCNEC) is a very rare aggressive neuroendocrine tumor with a high propensity to metastasize and very poor prognosis. We report an atypical presentation of lung LCNEC was diagnosed from a metastatic nodule on the breast. METHODS Our patient is a 59-years-old woman that presented in March 2014 nonproductive cough. A CT scan showed multiple brain, lung, adrenal gland and liver secondary lesions; moreover, it revealed a breast right nodule near the chest measuring 1.8 cm. The breast nodule and lung lesions were biopsied and their histology and molecular diagnosis were LCNEC of the lung. To our knowledge, this is the first documented case of breast metastasis from LCNEC of the lung. RESULTS Furthermore, breast metastasis from extramammary malignancy is uncommon and its diagnosis is difficult but important for proper management and prediction of prognosis. Therefore, a careful clinical history with a thorough clinical examination is needed to make the correct diagnosis. Moreover, metastasis to the breast should be considered in any patient with a known primary malignant tumor history who presents with a breast lump. Anyhow, pathological examination should be performed to differentiate the primary breast cancer from metastatic tumor. CONCLUSION Therefore, an accurate diagnosis of breast metastases may not only avoid unnecessary breast resection, more importantly it is crucial to determine an appropriate and systemic treatment.
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Affiliation(s)
- Anselmo Papa
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Luigi Rossi
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Monica Verrico
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Claudio Di Cristofano
- Histopathology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Valentina Moretti
- Histopathology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Martina Strudel
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Federica Zoratto
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Marina Minozzi
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Silverio Tomao
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
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9
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Kumar JI, Yanamadala V, Shin JH. Intramedullary spinal metastasis of a carcinoid tumor. J Clin Neurosci 2015; 22:1990-1. [PMID: 26260116 DOI: 10.1016/j.jocn.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/01/2015] [Indexed: 01/23/2023]
Abstract
We report an intramedullary spinal cord metastasis from a bronchial carcinoid, and discuss its mechanisms and management. Intramedullary spinal cord metastases from any cancer are rare, and bronchial carcinoids account for only a small fraction of lung cancers. To our knowledge, an intramedullary spinal cord metastasis from a bronchial carcinoid has been described only once previously.
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Affiliation(s)
- Jay I Kumar
- Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
| | - Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
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10
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Knafo S, Pallud J, Le Rhun E, Parker F, Iakovlev G, Roux FX, Page P, Meder JF, Emery E, Devaux B. Intradural Extramedullary Spinal Metastases of Non-neurogenic Origin. Neurosurgery 2013; 73:923-31; discussion 932. [DOI: 10.1227/neu.0000000000000132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Leptomeningeal metastases from carcinoma are still poorly understood.
OBJECTIVE:
To better define the management of unique intradural extramedullary spinal metastases (IESM) from solid cancers of non-neurogenic origin, in particular regarding leptomeningeal metastasis (LM).
METHODS:
We conducted a retrospective, multicenter, case-control study including 11 patients with IESM matched with 11 patients with LM. Primary endpoint was overall survival; secondary endpoints were diagnostic criteria and prognostic factors.
RESULTS:
Descriptive analysis showed a clinically significant difference between IESM and LM patients regarding preexisting neurological deficit (45.5% vs 90.1%, P = .06) and malignant cells in cerebrospinal fluid (0% vs 54.5%, P = .03). The median overall survival was significantly higher for IESM patients (732 days) than for patients with LM (53 days; P < .0002). Multivariate analysis showed that preexisting neurological deficit was a negative prognostic factor for overall survival (hazard ratio: 10.2; 95% confidence interval: 1.88-102; P = .04), in contrast to functional improvement with treatment (hazard ratio: 0.01; 95% confidence interval: 0.00-0.52; P = .04). We propose the following diagnostic criteria for IESM: (1) a solid lesion located within the intradural extramedullary space, (2) the absence of other leptomeningeal lesion seen on full-spine injected magnetic resonance imaging, (3) the absence of malignant cells in cerebrospinal fluid, and (4) a histological confirmation of the metastatic nature of the lesion.
CONCLUSION:
The significant difference in survival between IESM and LM suggests that they are 2 distinct evolutions of the metastatic disease. Distinguishing IESM also has therapeutic consequences because patients can benefit from a focal surgical treatment with functional improvement and extended survival.
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Affiliation(s)
- Steven Knafo
- Department of Neurosurgery, Pitié-Salpétrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France
- University Paris Descartes, Paris, France
| | - Emilie Le Rhun
- Centre de Lutte contre le Cancer Oscar Lambret, Lille, France
| | - Fabrice Parker
- Department of Neurosurgery, Bicêtre Hospital, University Paris Sud, Le Kremlin-Bicêtre, France
| | - Gueorgui Iakovlev
- Department of Neurosurgery, Beaujon Hospital, University Paris Diderot, Paris, France
| | - François-Xavier Roux
- Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France
- University Paris Descartes, Paris, France
| | - Philippe Page
- Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France
- University Paris Descartes, Paris, France
| | - Jean-François Meder
- Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France
- Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen Hospital, Caen, France
| | - Bertrand Devaux
- Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France
- University Paris Descartes, Paris, France
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11
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Hénaux PL, Zemmoura I, Riffaud L, François P, Hamlat A, Brassier G, Morandi X. Surgical treatment of rare cauda equina tumours. Acta Neurochir (Wien) 2011; 153:1787-96. [PMID: 21789588 DOI: 10.1007/s00701-011-1094-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 07/14/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cauda equina tumours (CET) are rare and usually benign. Treatment of schwannomas and benign ependymomas, which are the most frequent histopathological types of CET, is now well established. However, management of other presumed histopathological types of CET is still a matter of debate. The aim of this study was to assess the incidence and the surgical treatment of rare CET. METHOD A retrospective study was carried out on 176 adult patients surgically treated for CET in our two departments from 1994 to 2010. We reviewed pre- and postoperative symptoms, magnetic resonance imaging aspects, surgical findings, outcome including operative neurological morbidity, local recurrence rate and operative mortality, and incidence of rare CET. FINDINGS Seventeen percent (30 patients) of CETs operated on were neither schwannomas nor benign ependymomas. Half of these cases were benign tumours, with paragangliomas being the most common. Two patients were in poorer clinical condition after surgery, one patient experienced a local recurrence, and one died following surgery, from the progress of his disease (Von Hippel-Lindau disease). The other half were malignant tumours, with metastases being the most common. One third of the patients were worsened by surgery, and the mortality rate was 1/3 at 8 months (1-27 months). CONCLUSIONS Roughly one in six CET were neither schwannomas nor benign ependymomas. This study demonstrated the efficiency of surgery for rare benign CET with a low local recurrence rate. Surgical treatment of rare malignant CET led to a high rate of increased postoperative neurological deficit in patients with a reduced life expectancy.
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Affiliation(s)
- Pierre-Louis Hénaux
- Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
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