Intradural spinal metastasis of renal cell cancer. Report of a case and review of 26 published cases

Abstract

Metastatic disease in the intradural compartment of the spine is a rare manifestation of cancer. We report the case of an 82-year-old patient with an intradural, extramedullary metastasis of renal cell carcinoma in the cervical spine. A literature search for intradural spinal metastases of renal cell carcinoma yielded a total of 26 further cases. 18 patients had sporadic renal cell carcinoma, and 9 patients had von Hippel-Lindau disease (VHL) in which the metastases of the renal cell carcinoma were embedded within spinal haemangioblastomas. Patients presented with paresis, back pain, altered sensation or, less frequently, bladder dysfunction. Intradural spinal metastases were diagnosed at an earlier age in VHL patients than in sporadic cases (mean 43 +/- 5 years vs. 60 +/- 14.5 years). The metastasis was surgically removed in 81% of patients. Pain improved in all patients, paresis in 90%, hypaesthesia in 38% and bladder dysfunction in 50%. Death occurred as a result of systemic cancer progression. 93% of patients in the sporadic renal cell cancer group died within 1.5 years, whereas two thirds of the VHL patients were alive after 2 years.

Surgical treatment options and management strategies of metastatic renal cell carcinoma to the lumbar spinal nerve roots

“…In a previous review of 26 patients, patients with sporadic disease (unrelated to von Hippel-Lindau [VHL] syndrome) received an initial diagnosis of primary RCC at 57 ± 13 years and diagnosis of the spinal cord metastasis at 60 ± 14.5 years. 1 33% of these patients had no evidence of other metastases, similar to other series. 1–7 Given the overall rarity of this lesion, each patient contributes to the overall understanding of disease presentation and management.…”

“…1 33% of these patients had no evidence of other metastases, similar to other series. 1–7 Given the overall rarity of this lesion, each patient contributes to the overall understanding of disease presentation and management.…”

“…4,7–11 Some remain intramedullary, and others are similar to nerve sheath tumors in their rubbery consistency and clear demarcation. 1,9 Peripheral endoneural metastases of RCC have also been diagnosed up to 4 years after surgical removal of the primary tumor. 12 Although rare, the incidences of cervical, thoracic, and lumbar tumors are equal, with sacral lesions being less common.…”

“…12 Although rare, the incidences of cervical, thoracic, and lumbar tumors are equal, with sacral lesions being less common. 1,13 …”

“…1 Patients with VHL have a better prognosis postoperatively, which may be attributed to being diagnosed early, with a pre-existing hemangioblastoma later being seeded by RCC. 4,14–18 In fact, RCC has also been shown to seed hemangioblastomas of the medulla and cerebellum.…”