Perineural Spread of Renal Cell Carcinoma: A Case Illustration with a Proposed Anatomic Mechanism and a Review of the Literature

Capek, Stepan; Krauss, William E.; Amrami, Kimberly K.; Parisi, Joseph E.; Spinner, Robert J.

doi:10.1016/j.wneu.2016.01.060

Cited by 16 publications

(14 citation statements)

References 47 publications

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“…This proposition is consistent among case reports with a known lung primary malignancy [5]. Other, more complex routes have also been described which include renal cell carcinoma spreading along the autonomic nerves to the aorticorenal, celiac, and mesenteric ganglia and then along the thoracic and lumbar splanchnic nerves to the corresponding spinal nerves to the intradural, extramedullary space [13].…”

Section: Mechanism Of Metastasissupporting

confidence: 82%

“…It is unclear which route was utilized in our case, but given our patient's known and documented intracranial metastatic lesions, we propose that the lesion was the result of spread from the sub-arachnoid space. In fact, the most commonly advocated mechanism in the literature reviewed was leptomeningeal spread [7,[9][10][11][12][13]. It follows that concurrent intracranial disease is likely to create metastatic disease given the fact that >50% of cases with an intracranial malignancy will demonstrate neoplastic cells in the CSF [9].…”

Section: Mechanism Of Metastasismentioning

confidence: 99%

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Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.

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Section: Mechanism Of Metastasissupporting

confidence: 82%

Section: Mechanism Of Metastasismentioning

confidence: 99%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

View full text Add to dashboard Cite

show abstract

“…There has been one case of renal cell carcinoma spreading along the autonomic nerves to the aorticorenal, celiac, and mesenteric ganglia and then along the thoracic and lumbar splanchnic nerves to the corresponding spinal nerves to the intradural, extramedullary space. 29 Further research is necessary to identify factors that predispose neoplasms to metastasize via specific routes to the intradural space. Intraoperatively also, the nerve roots were completely encased by the mass.…”

Section: Discussionmentioning

confidence: 99%

Intradural Extramedullary Metastasis from Primary Carcinoma of Breast via Brachial Plexus Perineural Spread: A Case Report and Review of Literature

Dandekar¹,

Chaudhari

2022

Asian J Neurosurg

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Intradural extramedullary metastasis from breast carcinoma is a rare occurrence. Furthermore, patients with primary breast carcinoma presenting with neurological symptoms in the first place are even rarer, which was the case in our patient. A 60-year-old woman presented with left upper limb monoparesis for 2 years and rapidly progressive weakness in the left lower limb for 1 week. The patient was evaluated and investigated to find primary left breast carcinoma with metastasis to multiple sites including C5-T1 intradural extramedullary spread. The patient was treated surgically, and decompression and tissue diagnosis were achieved to form a base for starting adjuvant therapy and safeguarding further neurological deterioration due to cord compression. In advanced metastatic cancer, preservation of neurologic function is the goal of surgical treatment. Thorough evaluation of patients presenting with a neurological deficit is always mandatory. Patient education is equally important for palliative treatment as well as to help reduce the burden of metastatic diseases.

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“…5,8 A study has proposed that perineural dissemination may also occur, spreading from the renal plexus through the sympathetic chain, and then to the intradural space, also affecting the cauda equina in some cases. 9 The clinical features of spinal metastasis are vast and include symptoms due to local periosteal lesions, to adjacent tissue invasion, and, lastly, due to the compression of the roots of the nerves. 4 In general terms, the patients can present with pain, autonomic symptoms, motor and sensitive deficits.…”

Section: Discussionmentioning

confidence: 99%

Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report

et al. 2019

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Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system. Case Report A male adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, a metastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital. Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part in maintaining the performance and the quality of life of the patient.

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Perineural Spread of Renal Cell Carcinoma: A Case Illustration with a Proposed Anatomic Mechanism and a Review of the Literature

Cited by 16 publications

References 47 publications

Intradural extramedullary metastasis: a review of literature and case report

Intradural extramedullary metastasis: a review of literature and case report

Intradural Extramedullary Metastasis from Primary Carcinoma of Breast via Brachial Plexus Perineural Spread: A Case Report and Review of Literature

Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report

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