Delayed Epidural Mucin Collection after Surgery for Spinal Metastatic Pancreatic Adenocarcinoma

Abstract

A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper-thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography. Radiotherapy for spinal metastasis and subsequent chemotherapy was carried out. Sixteen months after pancreatectomy, gait disturbance occurred and follow-up thoracic magnetic resonance imaging (MRI) showed aggravation of metastasis at T2 and T4 compressing the spinal cord. We performed a decompressive laminectomy with subtotal resection of the tumor masses and pedicle screw fixation at C7–T6. Neurologic status improved after the operation. Histopathologic examinations revealed the tumor as metastatic mucin producing adenocarcinoma. Three months after surgery, motor weakness and pain was reappeared. MRI showed large amount of epidural fluid collection. We performed wound revision and there was large amount of gelatinous fluid at the epidural space. We suggest that postoperative mucin collection and wound problems should be considered after surgery for mucin producing metastatic pancreatic tumor.

Clinical characteristics and surgical treatment of spinal metastases from pancreatic cancer: a single-center retrospective study

“…Imaging examination is important for the early diagnosis of MSPC. The X-ray or CT of MSPC may show osteogenic or osteolytic bone destruction, which is consistent with the results of our study (7)(8)(9). It is easy to miss the diagnosis with early X-ray plain films.…”

“…For patients with pancreatic cancer, treatment after spinal metastasis is particularly important to improve the quality of life (9,11,12). Because of the poor prognosis of the primary tumor, MSPC has not received sufficient attention in clinical practice and has been described in a limited number of case reports or case series (7)(8)(9). There is a lack of clinical treatment experience for this situation, and there is no consensus on the treatment strategy.…”

“…However, the pain lacks specificity and symptoms are often hidden, which can easily lead to missed diagnosis and misdiagnosis (7)(8)(9)13,14). Consistent with other spinal metastasis types, the location of the spinal cord injury in MSPC cases dictates the resultant neurological deficits (7)(8)(9). Cervical spinal cord compression often manifests as upper limb dysfunction, dizziness, and weakness.…”

“…With the evolution of diagnosis and treatment methods, surgery is one of the comprehensive treatment measures for spinal metastases, and its key role has been widely recognized and clinically confirmed (7)(8)(9). The purpose of surgical treatment for MSPC is to relieve pain, reduce and prevent damage to the neurological system, ensure immediate or stable improvement in spinal stability, and maximize patient's quality of life (7-9,21).…”

“…Few studies to date have reported on spinal metastases from pancreatic cancer, only seen in some case reports or small-scale case series studies (7)(8)(9). In the present retrospective study, we assessed data pertaining to four cases of MSPC that received spinal surgical intervention in a single center over 10 years.…”