Metástasis intramedular como primera manifestación de un carcinoma renal

Abstract

We present the case of a 69 year-old male without known antecedente who presented a clinical loss of distal force in his lower limbs during the last two months. Magnetic resonance imaging (MRI) showed an intramedullary spinal cord mass at the level of the medullaris cone. The patient was operated on; the histological diagnosis was clear cells carcinoma suggestive of metastasis from an unsuspected renal tumor that was later confirmed with an abdominal CT. When the patient's state is good, surgery can correct the neurological deficit produced by an intramedullary spinal cord lesion. The neurological state of our patient improved after the intervention, and 14 months after surgery, he has no neurological deficit in the lower limbs.

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

“…In the majority of sporadic cases (13 of 18, 72%), ISCM occurred after renal cell carcinoma had already been diagnosed, at a mean latency of 4.3 years (range 2 months to 15 years). In the remaining 5 patients (28%), ISCM was the first manifestation of disease [11,13,16,19,39]. When ISCM was diagnosed, 6 patients (33%) had no other metastases [2,5,13,23,29,39].…”

“…When ISCM was diagnosed, 6 patients (33%) had no other metastases [2,5,13,23,29,39]. Among the 12 patients (66%) with systemic disease, 9 (50%) had involvement of the lungs [11,13,16,24,33,41] and 4 (22%) of the brain [13,15], while a further 4 patients developed brain metastases later on [13,33,41]. Metastasis to the brain was a frequent event in RCC (44% of all patients).…”

“…See text for details. Scale bar 50 µm, all images same magnification[5,11,13,23] and 13 (93%) within 1.5 years[5,11,13,15,16,23,28,39]. Only 1 patient survived for 3 years[41].…”

Clinical Spectrum of Patients with Renal Cell Carcinoma

“…Back pain and sciatica due to metastatic nerve root infiltration of lumbo sacral nerves have been reported in RCC patients (Shakeel et al, 2009). Intramedullary spinal metastasis that are the rarest type of spinal involvement have also been reported as the presenting sign in RCC (Asadi et al, 2009;Donovan& Freeman, 2006;Gómez de la Riva et al, 2005;Schijns et al, 2000). Although uncommon, an occult cancer such as renal cell carcinoma needs to be considered in differential diagnosis of the above-mentioned syndromes.…”