Intramedullary spinal cord metastases in breast cancer: report of four cases and review of the literature

Abstract

Intramedullary spinal cord metastases (ISCM) are usually the result of rapidly progressing systemic cancer. Breast cancer represents one of the most common solid tumors associated with the development of ISCM at rather advanced stages of disease. In the present report we describe four new cases with advanced breast cancer developing ISCM. All cases presented herein indicated that ISCM is a late manifestation of disseminated breast cancer. Three of these patients had been treated for approximately 1-3 years for metastatic disease. Once ISCM developed, concurrent asymptomatic brain metastases were detected in one case, concurrent symptomatic brain disease (cerebellar) was present at the time of cervical ISCM diagnosis in another patient, and in another case, ISCM developed metachronously at 18 months after the diagnosis of symptomatic brain metastases treated by whole brain radiotherapy. One of these cases had brain metastases at presentation, while at relapse developed leptomeningeal carcinomatosis treated successfully, but followed shortly, as a terminal event, by ISCM and parenchymal brain recurrence. All but one patient experienced a rather rapidly evolving disease course leading to death after 2-5 months from widespread neuraxis dissemination of their cancer, while one patient is still alive 6 months after the diagnosis of ISCM. All four cases, added to the list of the anecdotally reported cases of ISCM after breast cancer, undermine the ominous prognosis and limited treatment options available for this disease manifestation, and an extensive literature review and discussion of similar cases is provided.

Intramedullary Spinal Cord Metastasis from Malignant Mesenchymal Tumor: Detection with FDG-PET/CT

“…The routine imaging modality generally used for the diagnosis of intramedullary spinal cord metastasis is MRI. Other imaging techniques (CT, PET/CT, and angiography) are of limited significance (15,16). PET has a sensitivity rate of 96% in detecting spinal metastasis.…”

Two Separate Episodes of Intramedullary Spinal Cord Metastasis in a Single Patient with Breast Cancer

“…The metastasis of IDC to the CNS is generally a late feature of metastatic disease, and is thought to be hematogenous in origin 17) . Among them, about 90% cause brain metastases, and only 8% spread to the leptomeninges 12) . Once the tumor cells reach the leptomeninges, they are thought to spread to the spinal cord via the CSF 17) .…”

“…The incidence of intramedullary tumors in various studies of metastases affecting the spinal cord ranges from 0.1% to 6% incidence of central nervous system metastases, usually multifocal 4,13,14) . Metastatic tumors are mostly localized in the brain followed by the cerebellum, dura mater, brain stem, and intramedullary spinal cord 12) . In a later review of ISCM by Edelson et al 6) the incidence if ISCM was found to be 3.4%.…”

Metástase intramedular de carcinoma da tireóide: relato de caso

“…O quadro clínico é dependente do nível da lesão na medula espinhal, podendo ocorrer dor localizada ou de distribuição radicular, déficit motor e sensitivo, disfunção vesical e esfincteriana e síndrome de Bro w n -S é q u a rd , sendo a fraqueza muscular o sintoma mais freq ü e n t e 4 , 1 6 , 1 7 . Em 75% dos pacientes investigados o int e rvalo entre o aparecimento dos sintomas neuro l ó-gicos e o desenvolvimento do déficit neuro l ó g i c o completo é inferior a 1 mês 18,19 .…”