Brain Pathology Case of the Month - May 2019

FINAL DIAGNOSIS

Intramedullary spinal cord metastasis of small cell cancer of lung

DISCUSSION

Intramedullary spinal cord metastasis (ISCM) compromises only 1~3% of all intramedullary spinal cord neoplasms, which has no imaging features that distinguish them from primary intramedullary tumors (4)

(1). ISCM is probably the rarest type of CNS involvement from lung cancer(3), the mechanism of metastasis might be via three pathways: Hematogenous spread, direct intramedullary invasion by meningeal carcinomatosis, and direct invasion from contiguous structure. Thus, the patient with ISCM always had systemic metastases or brain metastases. ISCM acts as a late manifestation of disseminated malignant cancer, it's rare to appear an isolated ISCM which occurred as first distant metastasis without central nervous system and other organ involvement in the literature(1). The treatment of ISCM mainly consists of radiation therapy and steroid administration. However, for a solitary ISCM with systemic cancer control, the effectiveness of surgical resection has also been reported(42). In this case, the first treatment option is radical microsurgical removal of the tumor and additional treatment of radiotherapy according to the result of histopathological report. After conventional radiotherapy, the patient has a symptom improvement and the lesion disappeared in follow-up MRI.

REFERENCES

  1. Dam-Hieu P, Seizeur R, Mineo JF, Metges JP, Meriot P, Simon H (2009) Retrospective study of 19 patients with intramedullary spinal cord metastasis. Clinical neurology and neurosurgery.111(1):10-7.
  2. Garcia R, Sallabanda K, Santa-Olalla I, Lopez Guerra JL, Aviles L, Sallabanda M, et al. (2016) Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review. Cureus.8(5):e609.
  3. Kosmas C, Koumpou M, Nikolaou M, Katselis J, Soukouli G, Markoutsaki N, et al. (2005) Intramedullary spinal cord metastases in breast cancer: report of four cases and review of the literature. Journal of neuro-oncology.71(1):67-72.
  4. Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A, et al. (2013) Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World neurosurgery.79(3-4):576-84

Contributed by Lin Cai, MD, Zhang Zhang Zhu, MD, Jian Min Li, MD, Xiang He Lu, MD

International Society of Neuropathology