Atypical presentation of a cervical breast-cancer metastasis mimicking a dumbbell-shaped neurinoma

Abstract

INTRODUCTIONSpinal metastases are frequently encountered in patients with breast cancer. Because of recent improvements in oncologic therapies a growing incidence of symptomatic leptomeningeal metastases (LM) should be expected. The differential diagnosis of LM comprises a wide range of conditions, including neurinoma. The radiologic discrimination between metastases and neurinomas is primarily based on distinct neuroimaging features, particularly number, size and growth pattern.PRESENTATION OF CASEWe report the first case of a solitary leptomeningeal metastasis of a cervical nerve-root, which mimicked a benign dumbbell-shaped neurinoma, using neuroimaging and visualized intraoperatively. The tumor was successfully treated with surgery followed by adjuvant radiochemotherapy (RCT).DISCUSSIONWhile the patient history directs towards a metastasis, the localization, growth pattern and MRI signal were concordant with a cervical neurinoma. The current literature is not conclusive concerning the optimal choice of treatment; the therapy is strictly palliative and indications for surgery remain individual decisions. However, due to recent improvements in survival of patients with LM require reconsideration of established strategies.CONCLUSIONThe present case report and the reviewed literature point towards a growing clinical relevance of symptomatic LM in cancer patients and their possible atypical presentations and locations.

Rare Intradural Cervical Nerve Root Metastasis of Follicular Thyroid Carcinoma

“…It has been reported mainly in the thoracic [5-6] and lumbar [1-4] regions with one case of breast adenocarcinoma in the cervical spine [7]. Although there is a report of papillary thyroid carcinoma metastasizing to a thoracic nerve root in a patient with known cervical lymph node and sacroiliac joint spread several years following initial multi-modal therapies [6], our case is unique because it involves intradural metastasis to a ventral cervical nerve root of follicular thyroid carcinoma as a first sign of metastasis in a patient considered to be in remission for 10 years.…”

“…Subsequently, a handful of nerve root metastases have been reported in the thoracic to sacral regions. Only one case of cervical nerve root metastasis has been reported for breast adenocarcinoma, which has a higher propensity for metastasis [7]. However, this most likely occurred via the spinal fluid pathway as the patient had intra-cerebral metastasis.…”

“…The lumbar [1-4] and thoracic regions [5-6] tend to be more common areas of presentation, whereas cervical nerve root metastasis has been reported once for a case of breast cancer that spread via drop metastasis [7]. We report the first case of metastasis to and invasion of a ventral cervical nerve root in a patient previously diagnosed with low-grade thyroid carcinoma, who presented with right upper extremity radiculopathy and weakness after being in remission for several years.…”

Spinal Dumbbell Epidural Hemangioma: Two Stage/Same Sitting/Same Position Posterior Microsurgical and Transthoracic Endoscopic Resection – Case Report and Review of the Literature

“…Ninety percent of spinal dumbbell tumors are schwannomas, and up to 33% of schwannomas have a dumbbell form ( 19 , 23 ). Other dumbbell-shaped tumors include hemangiomas ( 6 , 12 ), meningiomas ( 28 ), malignant peripheral nerve sheath tumors ( 22 ), neurogenic paravertebral tumors with origin from neurogenic elements within the thorax ( 7 ) (including neuroblastoma ( 20 )), ganglioneuroblastoma ( 20 ), ganglioneuroma ( 3 ), hemangioblastomas ( 8 ), liposarcomas ( 31 ), lipoblastoma ( 32 ), angiomatosis ( 33 ), angiolipoma ( 34 ), rhabdomyosarcoma ( 35 ), spine extraosseus chordoma (SEC) ( 36 ), mesenchymal chondrosarcoma ( 37 ), soft tissue chondroma ( 38 ), osteochondroma ( 39 ), malignant glomus tumor ( 40 ), malignant solitary fibrous tumor ( 41 ), plasmocytoma ( 42 ), metastasis ( 43 ), Ewing sarcoma ( 44 ), atypical teratoid rhabdoid tumor ( 45 ), lymphoma ( 46 ), lymphangioma ( 47 ), meningeal melanocytoma ( 48 ), small cell malignant tumor ( 49 ), and peripheral primitive neuroectodermal tumor (PNET) ( 50 ).…”

Multiple nerve root metastasis of breast carcinoma: a report of two cases

“…Nerve root metastases are rare, and the literature is full of individual cases, with no large number of cases reported. A review of the current literature revealed only 15 cases of metastases to the spinal nerve root ganglia; arising from distant solid tumors, the primary lesions in those cases were pulmonary adenocarcinoma in 3 cases (2-4), renal cell carcinoma (RCC) in 3 cases (5,6), colonic adenocarcinoma in 2 cases (2,7), uterine adenocarcinoma in 1 case (8), a ductal breast carcinoma (1), a Ewing's sarcoma (9), a gastro-intestinal stromal tumor (10), a follicular thyroid carcinoma (11), a cervical cancer (12), and a cervical breast-cancer (13). Herein, we reported a patient with S1 nerve root and a patient with L5 bilateral cervical nerve root metastasis of breast adenocarcinoma.…”