Spinal cord metastasis from bronchogenic carcinoma. A case report

Significant antitumor response of disseminated glioblastoma to bevacizumab resulting in long-term clinical remission in a patient with encephalocraniocutaneous lipomatosis: A case report

The prognosis of recurrent and disseminated glioblastoma is very poor. Bevacizumab is an effective established therapy for recurrent glioblastoma following treatment with radiotherapy plus temozolomide. However, the efficacy of bevacizumab is limited to prolonging progression-free survival, without significant prolongation of the overall survival. We herein report a case of glioblastoma in a 32-year-old female patient with encephalocraniocutaneous lipomatosis (ECCL) that had disseminated following surgical resection and subsequent treatment with temozolomide and radiation therapy. The disseminated tumors disappeared completely after five courses of bevacizumab therapy. Surprisingly, the patient has remained in clinical remission for >2.5 years after dissemination by continuing this therapy. To the best of our knowledge, this is the first case of long-time clinical remission following glioblastoma dissemination and treatment with bevacizumab. In the present case, bevacizumab exerted an atypically strong antitumor effect against disseminated glioblastoma after multidisciplinary treatments had already been applied. Moreover, this is the first report of ECCL associated with a malignant brain tumor.

Metastases of the spinal cord from remote neoplasms. Study of five cases

Five patients with acute or subacute myelopathy are reported in whom neuroradiologic imaging or open surgery showed an intrinsic spinal cord tumor. Histologic diagnosis was obtained either through direct spinal cord biopsy or after biopsy or removal of a former or concurrent intracranial metastasis. Carcinoma of "possible" gastrointestinal origin, oat-cell carcinoma, melanoma, and bronchogenic adenocarcinoma in two cases were demonstrated. The clinical course showed a devastating and irreversible deterioration of the neurological condition in all patients but one, who exhibited a mildly symptomatic disease. Our uncertainty with cases of intramedullary spinal cord metastasis resulted in a nonstandardized approach to these patients. The role of magnetic resonance imaging, the radiotherapeutic option, and the pertinent literature are briefly discussed.

Clinical features and natural history of intramedullary spinal cord metastasis

Five cases of intramedullary spinal cord metastasis are presented and an additional 50 cases from the English language literature since 1960 are reviewed. Lung cancer and breast cancer were the most frequently occurring primary neoplasms, but a wide variety of solid tumors may cause intramedullary spinal cord metastasis. The presenting symptoms were pain and/or weakness. The neurologic status deteriorated rapidly in the majority of patients in a period to days to weeks. Progression to a cord hemisection syndrome or cord transection occurred in approximately half of the patients. The characteristic myelographic appearance of fusiform swelling of the cord was seen in one third of the patients, but the myelogram was normal in 42%. Plain radiographs of the spine showed no evidence of metastatic disease in three fourths of cases. The cerebrospinal fluid protein level was frequently elevated, but results of cytologic studies were usually negative. High-resolution computer-assisted tomographic scanning may show intramedullary metastases. Radiation therapy combined with corticosteroid administration offers the only effective palliation. The recognition of intramedullary spinal cord metastasis is an ominous finding. Intramedullary spinal cord metastasis generally occurred in the setting of widespread systemic and intracranial disease, but occasionally was the only site of relapse. More than 80% of patients died within 3 months. Heightened awareness of this entity may lead to early diagnosis at a stage when neurologic deficits are reversible and, it is hoped, more effective palliation can be achieved.

Myelography in metastatic lesions

The radiologic appearances at gas myelography were analysed in 57 metastatic lesions, all histologically verified, or having known primary tumours. Five of these cases were also examined with a water-soluble contrast medium, metrizamide. The results were correlated to the findings at surgery and to tumour pathology. It is concluded that myelographic findings simulating juxtamedullary growth are usually due to local indentation of the dura by the extradural tumour, and not to intradural extension.