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Intramedullary spinal cord metastases: an institutional review of survival and outcomes. J Neurooncol 2019; 142:347-354. [DOI: 10.1007/s11060-019-03105-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/11/2019] [Indexed: 01/12/2023]
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Ravindra VM, Mazur MD, Driscoll M, McEvoy S, Schmidt MH. BRCA2-positive spinal intramedullary ovarian metastatic disease: case report. Spine J 2016; 16:e201-7. [PMID: 26552643 DOI: 10.1016/j.spinee.2015.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread. PURPOSE The authors discuss the management and surgical decision making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature. STUDY DESIGN/SETTING A case report was used. METHODS The authors describe a case of a 59-year-old woman with Breast Cancer gene (BRCA) 2-positive ovarian cancer who developed progressive myelopathy from a T10 to T11 intramedullary metastatic lesion. RESULTS The patient underwent a standard open T10-T11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative magnetic resonance imaging at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease 1 year after surgery. CONCLUSION Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurologic deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meghan Driscoll
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sara McEvoy
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Rostami R, Safarpour D, Tavassoli FA, Jabbari B. Intramedullary metastasis in breast cancer – A comprehensive literature review. J Neurol Sci 2013; 332:16-20. [DOI: 10.1016/j.jns.2013.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 11/15/2022]
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Hsu KC, Li TY, Chu HY, Chen LC, Chang ST, Wu YT. Conus medullaris metastasis in breast cancer: report of a case and a review of the literature. Surg Today 2012; 43:910-4. [DOI: 10.1007/s00595-012-0289-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/15/2012] [Indexed: 11/28/2022]
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Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A, Erasmus A, Hunn A. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 2012; 79:576-84. [PMID: 22484768 DOI: 10.1016/j.wneu.2012.04.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 10/30/2011] [Accepted: 04/03/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To review previous reports as well as our institutional experience to address the issues regarding patient management and also to assess the predisposing factors that might influence outcome and survival. METHODS We undertook a 20-year (1989-2009) retrospective study of a series of eight patients diagnosed with intramedullary spinal cord metastases (ISCMs) in our institute. We further reviewed 293 cases of ISCMs reported in the English literature since 1960. Characteristics regarding the site of the primary cancer, location of ISCM, the presence of other metastases, presenting neurological symptoms/signs, duration of symptoms, and the time interval from diagnosis of the primary tumor to ISCM were pooled. We analyzed the different treatment approaches, the functional outcome, and the factors influencing survival. RESULTS Lung and breast cancers appear to be the most frequent source of ISCM with cervical, thoracic, and lumbar spine being equally affected. Motor weakness predominates as the commonest symptom at presentation, followed by pain and sensory disturbance. At diagnosis, most patients with ISCM have a known primary cancer often associated with cerebral and other systemic metastases. Overall survival of ISCM is poor (median: 4 months from the time of diagnosis). Survival in surgical patients is 6 months, compared with 5 months in those conservatively managed. Clinical improvement was observed in more than one-half of those treated surgically, whereas neurological status was maintained in most patients treated conservatively. CONCLUSION ISCM is an unusual site for metastasis. Regardless of the treatment, its prognosis is generally poor as its presence often signifies end-stage cancer. However, with early diagnosis and appropriate treatment, selected patients may benefit from improved neurological outcome and quality of life.
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Affiliation(s)
- Wen-Shan Sung
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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Wilson DA, Fusco DJ, Uschold TD, Spetzler RF, Chang SW. Survival and functional outcome after surgical resection of intramedullary spinal cord metastases. World Neurosurg 2011; 77:370-4. [PMID: 22120329 DOI: 10.1016/j.wneu.2011.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/28/2011] [Accepted: 07/08/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Intramedullary spinal cord metastasis (ISCM) is a rare manifestation of systemic cancer and data about the optimal management of these lesions are lacking. To clarify the role of surgery, we investigated survival and neurological outcomes after surgical resection of ISCMs. METHODS Between 2003 and 2010, we surgically treated 10 ISCMs in 9 patients. For each patient, we retrospectively collected the following data: demographic variables, history of prior cancer, site of primary cancer, extent of cancer on presentation, degree of resection, preoperative and postoperative spinal cord impairment (American Spinal Injury Association [ASIA] grade), and postoperative survival. We investigated the relationship between these variables, overall survival, and preservation of function. RESULTS Eight ISCMs were treated with gross total resection and two were treated with subtotal resection. Overall postoperative survival was 6.4 ± 9.4 months (mean ± standard deviation), with one patient still alive at last follow-up. Patients with a diagnosis of melanoma had higher mean survival than those with nonmelanoma histology (20.5 ± 13.4 vs. 2.4 ± 1.7 months, P < 0.01). Degree of resection, number of organ systems affected, ambulatory status, and ASIA grade pre operatively or postoperatively, were not significantly associated with survival. Of the nine patients, seven (78%) demonstrated no change in ASIA grade postoperatively, one (11%) improved, and one patient (11%) deteriorated. All patients who were ambulatory preoperatively remained ambulatory postoperatively and at last follow-up. CONCLUSIONS Although ISCM is associated with poor prognosis, survival appears to be greater in patients with melanoma. Surgical resection does not appear to significantly lengthen survival but may be indicated to preserve ambulatory status in symptomatic patients.
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Affiliation(s)
- David A Wilson
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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7
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Hrabalek L. Intramedullary spinal cord metastases: review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154:117-22. [PMID: 20668492 DOI: 10.5507/bp.2010.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS To review the epidemiology, dissemination, clinical presentation, diagnosis, treatment, survival and functional outcome of intramedullary spinal cord metastases (ISCM). METHODS Literature review of all surgically treated cases of ISCM and all described cases of ISCM of breast carcinoma. RESULTS 42 references to 87 surgically treated cases of ISCM were found, 13 references to 27 cases with diagnosed and treated ISCM of breast carcinoma. In only 9 cases of spinal cord metastases of breast cancer was surgical resection of ISCM done (10% of all surgically treated ISCM). CONCLUSIONS Three treatment modalities are available for ISCM: radiotherapy, chemotherapy, and surgery. The gold standard remains radiotherapy. Microsurgical resection of a focal intramedullary mass appears to be feasible and should be considered in selected cases. Patients who have no evidence of widespread organ metastases or multiple intramedullary lesions and who have a life expectancy of at least a few months with tumours of non-lymphoma histology should be considered for tumor resection. In conclusion, ISCM are difficult to treat lesions, but early diagnosis, careful surgical management and maintenance therapy may substantially contribute to a satisfactory functional outcome and prolonged survival.
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Affiliation(s)
- Lumir Hrabalek
- Department of Neurosurgery, Palacky University and University Hospital Olomouc.
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Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 2010; 13:94-108. [PMID: 20594024 DOI: 10.3171/2010.3.spine09202] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With continued growth of the elderly population and improvements in cancer therapies, the number of patients with symptomatic spinal metastases is likely to increase, and this is a condition that commonly leads to debilitating neurological dysfunction and pain. Advancements in surgical techniques of resection and spinal reconstruction, improvements in clinical outcomes following various treatment modalities, generally increased overall survival in patients with metastatic spine disease, and a recent randomized trial by Patchell and colleagues demonstrating the superiority of a combined surgical/radiotherapeutic approach over a radiotherapy-only strategy have led many to suggest increasingly aggressive interventions for patients with such lesions. Optimal management of spinal metastases encompasses numerous medical specialties, including neurosurgery, orthopedic surgery, medical and radiation oncology, radiology, and rehabilitation medicine. In this review, the clinical presentation, diagnosis, and management of spinal metastatic disease are discussed. Ultimately, the goal of treatment in patients with spinal metastases remains palliative, and clinical judgment is required to select the appropriate patients for surgical intervention.
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Affiliation(s)
- Daniel M Sciubba
- Departments of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
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Conforti R, Tagliatatela G, De Cristoforo M, Di Costanzo A, Scuotto A, Sanpaolo S, Dericoloso A, Cirillo S. Lung cancer single intramedullary metastasis vs delayed radionecrosis. A case report. Neuroradiol J 2009; 22:458-63. [PMID: 24207155 DOI: 10.1177/197140090902200417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 08/07/2009] [Indexed: 11/17/2022] Open
Abstract
Intramedullary metastases are rare, accounting for 0.9-5% of spinal metastases. Radiation myelopathy is considered one of the most distressing complications of radiotherapy. In both cases symptoms are aspecific, and there are no characteristic neuroradiologic findings. We describe a case of single intramedullary metastasis from lung microcytoma in a 55-year-old man with a history of malignancy, treated by radiotherapy five years previously. The patient returned to our observation complaining of pain and paraesthesia in the left C7 area. Spinal MRI and rachicentesis findings were aspecific. Ten days later a new MRI showed that the lesion size had increased, and neoplastic cells were found in CSF. Intramedullary metastases are extremely rare, accounting for 0.1-0.4% of all CNS tumors. The risk of developing delayed radionecrosis varies with the total dose administered. In both cases diagnosis is histological, while contrast-enhanced MRI is highly sensitive and specific in identifying and characterizing the lesion. In case of metastatic lesions the prognosis is unfavorable. Differential diagnosis is important because it has a strong effect on patient management.
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Affiliation(s)
- R Conforti
- Department of Neuroscience, Neuroradiology, Second University of Naples; Naples, Italy -
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Dam-Hieu P, Seizeur R, Mineo JF, Metges JP, Meriot P, Simon H. Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clin Neurol Neurosurg 2008; 111:10-7. [PMID: 18930587 DOI: 10.1016/j.clineuro.2008.06.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 06/21/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022]
Abstract
OBJECT Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival. PATIENTS AND METHODS We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed. RESULTS Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients. CONCLUSIONS Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.
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Affiliation(s)
- Phong Dam-Hieu
- Department of Neurosurgery, University of Bretagne Occidentale, School of Medicine and University Medical Center, Brest, France.
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11
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Gazzeri R, Galarza M, Faiola A, Gazzeri G. Pure intramedullary spinal cord metastasis secondary to gastric cancer. Neurosurg Rev 2006; 29:173-7. [PMID: 16465555 DOI: 10.1007/s10143-005-0015-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 11/06/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
Pure intramedullary spinal-cord metastases (ISCM) are a rare manifestation of cancer. We report a case of ISCM from gastric cancer. A 68-year-old man, treated with total gastrectomy for a gastric cancer, presented 9 months later with paresis of the left arm, pain and dissociated sensory loss. Magnetic resonance imaging revealed a pure intramedullary lesion at the C3-C5 level. After surgical resection, pathological findings revealed an undifferentiated adenocarcinoma of gastric origin. To our knowledge, this is only the second report of ISCM from gastric cancer in the literature.
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Affiliation(s)
- Roberto Gazzeri
- UOD Neurochirurgia, Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy.
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Rastelli F, Benedetti G, Di Tommaso L, Mazzoli M, Calbucci F, Crinò L. Intramedullary spinal metastasis from ovarian cancer. Lancet Oncol 2005; 6:123-5. [PMID: 15683822 DOI: 10.1016/s1470-2045(05)01742-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Kosmas C, Koumpou M, Nikolaou M, Katselis J, Soukouli G, Markoutsaki N, Kostopoulou V, Gaglia A, Mylonakis N, Karabelis A, Pectasides D. Intramedullary spinal cord metastases in breast cancer: report of four cases and review of the literature. J Neurooncol 2005; 71:67-72. [PMID: 15719278 DOI: 10.1007/s11060-004-9177-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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.
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Affiliation(s)
- Christos Kosmas
- Second Department of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece.
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Gómez de la Riva A, Isla A, Pérez-López C, Budke M, Gutiérrez M, Frutos R. Metástasis intramedular como primera manifestación de un carcinoma renal. Neurocirugia (Astur) 2005. [DOI: 10.1016/s1130-1473(05)70402-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cormio G, Di Vagno G, Di Fazio F, Loverro G, Selvaggi L. Intramedullary Spinal Cord Metastasis from Ovarian Carcinoma. Gynecol Oncol 2001; 81:506-8. [PMID: 11371147 DOI: 10.1006/gyno.2000.6186] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intramedullary spinal cord involvement by ovarian carcinoma is extremely rare. CASE A patient with stage IV serous cystadenocarcinoma of the ovary presented with neurologic complaints 16 months after primary treatment. Magnetic resonance imaging demonstrated a metastatic lesion in the intramedullary area of the spinal cord. No other site of metastatic disease was observed. The patient received three cycles of carboplatin with complete resolution of the neurologic symptoms and a remarkable reduction of the lesion. Following chemotherapy she was given radiotherapy on the spinal cord, but died 10 months later for disseminated abdominal disease, without neurologic symptoms. CONCLUSION Spinal cord involvement is unusual in ovarian carcinoma; multidisciplinary treatment, including chemotherapy and radiotherapy, may offer good palliation of the symptomatology.
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Affiliation(s)
- G Cormio
- Gynecologic Oncology Unit, University of Bari, Bari, Italy.
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Schijns OE, Kurt E, Wessels P, Luijckx GJ, Beuls EA. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000; 102:249-254. [PMID: 11154816 DOI: 10.1016/s0303-8467(00)00106-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors report the case of a 70-year-old woman who developed a Brown-Sequard-syndrome within 6 weeks caused by an intramedullary spinal cord metastasis of an occult renal cell carcinoma. Intramedullary metastases are rare and represent only 4-8.5% of central nervous system metastases. An important feature of intramedullary metastases is the rapid progression of neurological deficits which necessitates rapid treatment. There are only eight earlier reports of intramedullary metastasis due to renal cell carcinoma (Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 1996;47:906-12; Belz P. Ein Fall von intramedullaerer Grawitz-Metastase im Lumbalmark. Frankfurt Z Pathol 1912;10:431-44; Gaylor JB, Howie JW. Brown-Sequard-syndrome. A case of unusual aetiology. J Neurol Neurosurg Psychiatry 1938;1:301-5; Kawakami Y, Mair WGP. Haematomyelia due to secondary renal carcinoma. Acta Neuro Pathol 1973;26:85-92; Strang RR. Metastatic tumor of the cervical spinal cord. Med J Aust 1962;1:205-6; Von Pfungen. Uber einige Fälle von Haematomyelie nichttraumatischen Ursprungs. Wien Klin Rdsch 1906;20:44-50; Weitzner S. Coexistent intramedullary metastasis and syringomyelia of cervical spinal cord. Report of a case. Neurology 1960;674-8). To the best of our knowledge this is the first report on a patient in whom symptoms from the metastasis of a renal cell carcinoma preceded the detection of the primary tumor. This report presents the clinical, neuroradiological and histopathological findings of an intramedullary metastasis of a renal cell carcinoma and provides an overview of the literature on intramedullary spinal cord metastases.
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Affiliation(s)
- O E Schijns
- Department of Neurosurgery, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Sutter B, Arthur A, Laurent J, Chadduck J, Friehs G, Clarici G, Pendl G. Treatment options and time course for intramedullary spinal cord metastasis Report of three cases and review of the literature. Neurosurg Focus 1998. [DOI: 10.3171/foc.1998.4.5.6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical treatment of intrameduallary spinal cord metastases (ISCM) has become increasingly effective in recent years. The advent of new imaging techniques combined with an enhanced understanding of the natural history of these tumors has improved the effectiveness of the available treatment options. The authors present three new cases of ISCM successfully treated with surgery. A review of 129 cases found in the literature is also discussed. Characteristic symptomology and presentation are reviewed with an eye toward improving diagnostic methodology. The natural history of ISCM is divided into three phases. Surgical intervention should be used early in phase 2.
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Keung YK, Cobos E, Whitehead RP, Roberson GH. Secondary syringomyelia due to intramedullary spinal cord metastasis. Case report and review of literature. Am J Clin Oncol 1997; 20:577-9. [PMID: 9391544 DOI: 10.1097/00000421-199712000-00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intramedullary spinal cord metastasis is relatively rare. We describe a patient having intramedullary spinal cord metastasis associated with syringomyelia, confirmed by magnetic resonance imaging, in a patient who had poorly differentiated carcinoma of the lung. The patient responded to treatment with steroids and radiotherapy, with complete resolution of neurologic symptoms and syringomyelia.
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Affiliation(s)
- Y K Keung
- Department of Internal Medicine, Texas Tech University Health Sciences Center 79430, USA
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19
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Connolly ES, Winfree CJ, McCormick PC, Cruz M, Stein BM. Intramedullary spinal cord metastasis: report of three cases and review of the literature. SURGICAL NEUROLOGY 1996; 46:329-37; discussion 337-8. [PMID: 8876713 DOI: 10.1016/s0090-3019(96)00162-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intramedullary spinal cord metastasis is rare; but it is being encountered with increasing frequency. Optimal treatment after diagnosis remains controversial. METHODS In the last 3 years, we have encountered three cases of intramedullary metastasis presenting as focal mass lesions with minimal systemic evidence of cancer. We present our results in these patients and review the literature in an effort to more optimally define both the natural course of this disease, as well as a potential subset of patients who might benefit from more aggressive treatment. RESULTS With the availability of more sensitive imaging techniques, these tumors are being diagnosed with increasing frequency. Magnetic resonance imaging is sensitive, but nonspecific, in distinguishing intramedullary spinal cord metastases from primary cord tumors. Urgent biopsy is often necessary prior to definitive treatment. Radiation with chemotherapy significantly prolongs survival. Radical subtotal resection may offer additional quality survival, especially in cases of metastatic melanoma with an occult primary. CONCLUSIONS Regardless of treatment, many patients survive less than 1 year. Intramedullary spinal cord metastasis is a devastating condition, but with appropriate diagnosis and aggressive treatment, selected patients may have substantially increased survival.
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Affiliation(s)
- E S Connolly
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, USA
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20
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Intramedullary spinal cord metastasis from choroidal melanoma—A case report and review of literature. Radiography (Lond) 1996. [DOI: 10.1016/s1078-8174(96)90007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Okamoto H, Shinkai T, Matsuno Y, Saijo N. Intradural parenchymal involvement in the spinal subarachnoid space associated with primary lung cancer. Cancer 1993; 72:2583-8. [PMID: 8402479 DOI: 10.1002/1097-0142(19931101)72:9<2583::aid-cncr2820720912>3.0.co;2-k] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Intradural parenchymal involvement (IPI) in the spinal subarachnoid space associated with primary lung cancer is rare. A retrospective study was undertaken to investigate the clinical and pathologic features of IPI. METHOD A total of 1215 cases of primary lung cancer were studied at autopsy; the results were reviewed retrospectively. RESULTS Twenty (1.65%) of the cases revealed IPI in the spinal subarachnoid space. The histologic diagnoses were small cell carcinoma in ten cases, adenocarcinoma in eight cases, and squamous cell carcinoma in two cases. In 14 (70%) cases, the IPI was located between the lumbar and cauda equina of the spinal cord. However, no metastases were observed in the cervical spinal cord. Brain metastasis, vertebral metastasis, and meningeal carcinomatosis were seen in 70%, 60%, and 40% of the 20 cases, respectively, suggesting that these metastases may be related to the metastatic pathway to the spinal cord. Most patients had neurologic symptoms or signs referable to IPI; IPI could be diagnosed before death in only one patient by magnetic resonance imaging. The median interval between diagnosis of lung cancer and development of IPI and median survival after the onset of neurologic symptoms referable to IPI were 415 days and 110 days, respectively. CONCLUSION The authors retrospectively received 1215 autopsies of patients with primary lung cancer and found 20 (1.65%) with IPI.
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Affiliation(s)
- H Okamoto
- Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
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Stranjalis G, Torrens MJ. Successful removal of intramedullary spinal cord metastasis: case report. Br J Neurosurg 1993; 7:193-5. [PMID: 8388221 DOI: 10.3109/02688699309103478] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Intramedullary metastatic disease accounts for 5% of CNS metastases. This report describes a 47-year-old female with the simultaneous presentation of primary breast carcinoma and a solitary brain metastasis, both treated surgically. She represented with an increasing hemiparesis due to a spinal cord metastasis 4 years later. The cord lesion was removed microsurgically using a CO2 laser. Postoperatively she made a good recovery and lived independently for 2 years. The rationale for aggressive surgical treatment is discussed.
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Affiliation(s)
- G Stranjalis
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK
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23
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Thomas AW, Simon SR, Evans C. Intramedullary spinal cord metastases from epithelial ovarian carcinoma. Gynecol Oncol 1992; 44:195-7. [PMID: 1544599 DOI: 10.1016/0090-8258(92)90039-l] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient with poorly differentiated serous cystadenocarcinoma of both ovaries who had undergone extensive medical treatment presented with nonspecific neurologic complaints. With the aid of magnetic resonance imaging, a metastatic lesion in the intramedullary area of the spinal cord was diagnosed. Rapidly instituted high-dose steroids and radiotherapy resulted in resolution of her symptoms. Intramedullary spinal cord metastasis is an unusual metastatic site. This is the first reported case of epithelial ovarian carcinoma metastatic to the intramedullary spinal cord.
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Affiliation(s)
- A W Thomas
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212
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