Intramedullary spinal cord metastases: diagnosis and treatment – an illustrated review

Kalaycı, Murat; Çağavi, Ferda; Gül, Şanser; Yenıdünya, Sibel; Açıkgöz, Bektaş

doi:10.1007/s00701-004-0386-1

Cited by 176 publications

(248 citation statements)

References 41 publications

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“…1 Lung is the major origin followed by breast cancer. Colorectal cancer accounts for about 3% of ISCM cases 2 and only 18 cases have been reported. 3 When diagnosed, the patients are usually in an advanced stage of diseases.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Tsai

Lin

et al. 2016

Spinal Cord Ser Cases

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We report and analyze a rare entity of intramedullary spinal cord tumor, which is metastatic from colon cancer with a very poor prognosis. The reported 19 cases including our case in the literature are analyzed. Comparison of outcomes between surgery, radiotherapy and non-treatment groups are evaluated. Life distribution is profiled. Median overall survival is 75 days. The 90 days and 150 days survival rate are 42.9% and 21.4%, respectively. There were no differences between conservative treatment (non-treatment or radiotherapy) and aggressive intervention (surgery or surgery plus radiotherapy) in mortality and the trend of survival probability. The prognosis of metastatic intramedullary spinal cord tumor is poor. Surgery may only be considered in selected patients with good control of primary cancer and without evidence of lung metastases and leptomeningeal carcinomatosis.

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Section: Introductionmentioning

confidence: 99%

“…3 When diagnosed, the patients are usually in an advanced stage of diseases. 2 Surgery and radiotherapy are usually the choices of treatment but there is no a consensus of management.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Tsai

Lin

et al. 2016

Spinal Cord Ser Cases

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“…A third mechanism is the direct invasion from contiguous structures. Spread through the vertebral venous plexus (Batson's plexus) during the Valsalva manoeuvre enabling retrograde blood flow to the spinal cord is also possible [2]. But the three mechanisms about the pathophysiology of metastasis to spinal cord are no clear.…”

Section: Resultsmentioning

confidence: 99%

“…Other primary sources include primary breast and colorectal cancers [2]. Spinal magnetic resonance imaging (MRI) is routinely used to diagnose ISCM [3].…”

Section: Introductionmentioning

confidence: 99%

Drop Metastasis Seeding the Intramedullary Conus Medullaris in a Patient with Breast Cancer and Brain Metastasis

Chiang¹

2013

J Gen Pract

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Breast cancer metastasis to the conus medullaris is very rare. We report a case of intra-axial conus medullaris metastasis from breast adenocarcinoma in a 39-year-old woman. Two years after the diagnosis of brain metastasis was biopsy-proven, she developed progressive lower limb weakness with urinary incontinence for one month. MRI revealed a contrast-enhancing intramedullary lesion at the conus medullaris. Laminectomy and removal of the tumor were performed for decompression and for preserving function. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. We discuss the possibility of drop metastasis traveling from the brain to the conus medullaris via cerebrospinal fluid (CSF) in the central canal. Since intramedullary spinal cord metastasis can lead to rapid progressive neurological deficits and poor outcome, early diagnosis and decompression could preserve the quality of life. We suggest that CSF cytology could be helpful for the diagnosis of intraspinal metastasis in patients with brain metastasis. Jou rn a l o f Ge ner a l P r a c tic e Drop Metastasis Seeding the Intramedullary Conus Medullaris in a Patient

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“…Surgical treatment of spinal intradural carcinoma metastasis may improve survival (5,6), and radiotherapy may contribute to improving survival (3,7,8). We performed multimodal local therapies because our patient had a good performance status and local recurrence with the risk of brain stem compression.…”

Section: Discussionmentioning

confidence: 99%

A case of long-term survival after multimodal local treatments of intramedullary spinal cord metastasis of squamous cell lung cancer

et al. 2016

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Intramedullary spinal cord metastasis of non-small cell lung cancer is rare, and it has a short prognosis. We report a 53-year-old man diagnosed with cT4N0M0, stage IIIA squamous cell lung cancer.Ten months after left pneumonectomy (pT4N0M0), an intramedullary spinal cord tumor developed at the axis level. The intramedullary spinal cord tumor was resected, and he was diagnosed with metastatic squamous cell lung cancer. Radiotherapies and another tumor resection were conducted, as he had a good performance status and the discrete lesion was associated with the risk of brain stem compression.Multimodal local treatments for intramedullary spinal cord metastasis caused the tumor to shrink, and he lived for 25 months after the spinal metastasis occurred. After 25 months from the metastatic diagnosis, he died of respiratory arrest due to brain stem compression. Keywords DiscussionThe present patient's clinical course suggests two important clinical issues. First, metastatic squamous cell lung cancer of the intramedullary spinal cord can be detected in patients with a good performance status. However, it can be overlooked because of the following reasons. Intramedullary spinal cord metastasis of lung cancer is rare with an incidence rate of 1.65% and that of squamous cell lung cancer is especially rare at 0.16% on autopsy (1). The prognosis of intramedullary spinal cord metastasis of non-small cell lung cancer is short at approximately 5 months (2) and 23.5 months at the longest (3). Lastly, the neurologic symptoms are often confused with brain metastasis, meningitis carcinomatosa, or the side effects of chemotherapy (4). Thus, clinicians should perform brain and spinal cord MRI when they observe neurological deficits during the clinical course of lung cancer. improve survival (5,6), and radiotherapy may contribute to improving survival (3,7,8). We performed multimodal local therapies because our patient had a good performance status and local recurrence with the risk of brain stem compression. Therefore, surgery, radiotherapy, or a combination of both should be performed whenever feasible. Chemotherapy may be effective for intramedullary spinal cord metastases of small cell lung cancer (9), and tyrosine kinase inhibitors (TKI) may be effective against metastases originating from TKI-sensitive adenocarcinoma (10,11). Chemotherapy can be poorly effective for intramedullary metastases with low drug permeability due to the blood-spinal cord barrier (12). In our case, chemotherapies were ineffective even after surgeries that were supposed to break the blood-spinal cord barrier. Treatment of intramedullary metastases may be related to drug permeability and the nature of the chemoresistance of squamous cell lung cancer. Yet, despite the neurological complication, surgical and radiological treatment reduced the tumor size and improved the patient's survival. ConclusionsThis is a rare case of squamous cell lung cancer metastasizing to the intramedullary spinal cord, and our patient survived longer with multimodal l...

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Intramedullary spinal cord metastases: diagnosis and treatment – an illustrated review

Abstract: Early diagnosis and early surgical resection can result in improvement in neurological deficits and in the quality of life of patients with a Intramedullary spinal cord metastasis.

Cited by 176 publications

References 41 publications

Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Drop Metastasis Seeding the Intramedullary Conus Medullaris in a Patient with Breast Cancer and Brain Metastasis

A case of long-term survival after multimodal local treatments of intramedullary spinal cord metastasis of squamous cell lung cancer

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