Spinal intramedullary metastases. Report of two cases and review of the literature

Abstract

Two cases of intramedullary metastasis were observed in our department within a short period of time that change the picture of uncommon locations of spinal metastases as described in literature. The patients presented primarily with rapidly progressing flaccid paraparesis of the lower extremities. Both additionally described diffusely located hypesthesia and pallhypesthesia of the limbs. One complained about sphincter disturbance. Both were treated by laminectomy and microsurgical extirpation of the tumor. In the first case reported here, an intramedullary metastasis of an epithelioid sarcoma in the conus medullaris region was ascertained which may be regarded as the first such reported case. In the second case report, histologic findings confirmed a thoracic intramedullary metastasis of a mastocarcinoma. At follow-up 6 and 8 months postoperatively, we observed full recovery of neurologic function in one patient and partial recovery in the other. Intramedullary metastases are extremely rare. Clinical presentation may show rapid onset and outcome is related to rapid resection and adjuvant therapy. In contrast to intracerebral metastases, this is a remarkable incidence of sarcomatous intramedullary metastatic disease.

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

“…Table 5 are in line with other series: 1,3,8,20,24,27,40,52,63 ependymomas, astrocytomas, angioblastomas, and cavernomas constitute 86.4% of the total; all other pathologies are rare. Metastases, 21,45 melanocytomas, 18,25 intramedullary neuromas, 5,48 and meningiomas 10,49 are unusual intramedullary lesions mostly discussed as case reports in the literature.…”

“Drop metastasis”: a rare diagnosis. A case report and review of literature

“…Chemotherapy has been used in conjunction with radiation therapy or surgery in some chemotherapy sensitive tumours like small-cell carcinoma and haematological malignancies. 1,14,15 In patients treated with conservatively, 50% improve, 28% exhibit no change and 22% deteriorate. In patients who undergo a surgical resection, improvement is seen in 77% of the cases and no change in 23%.…”

“…Steroid therapy has no additional survival benefit, however, in patients with rapidly-progressive symptoms of cord compression, it may decrease pain and neurological dysfunction. 2,6,14 Aggressive surgery has been considered in selected patients, especially those presenting with previously undiagnosed or limited primary tumours, since it may improve the length and quality of survival.…”

“…, 1,14,15 Surgery as performed in 34% of published cases, could be considered as the optimal therapeutic approach but obviously carried high risks of postoperative functional impairment. Given the inherent risks of operating on the spinal cord and the usual state of advanced cancer, surgeons are reluctant to perform aggressive surgery.…”

“…Given the inherent risks of operating on the spinal cord and the usual state of advanced cancer, surgeons are reluctant to perform aggressive surgery. 1,14,15 The majority of patients with "drop metastasis" have a poor life expectancy due to synchronous brain metastases and a poor performance status secondary to neurological deficits, with a median survival of 3 to 4 months from the time of diagnosis. 1,8 Our patient had a 1 month survival since the diagnosis.…”