TITLE:
Multiple Spinal Intradural-Intramedullary Involvement by Metastatic Carcinoma with Neuroendocrine Differentiation with Occult Primary—An Unusual Case Report and Review of Literature
AUTHORS:
Anshu Gupta, Sachin Sinha
KEYWORDS:
Spinal Cord, Metastasis, Carcinoma, Neuroendocrine
JOURNAL NAME:
Open Journal of Pathology,
Vol.6 No.2,
April
20,
2016
ABSTRACT: Although vertebral column is recognized as the most common site
for bony metastasis in patient with systemic malignancy, intramedullary
metastases to the spinal cord is infrequent. Between 5% - 10% of cancer
patients develop spinal metastasis during the course of their diseases.
Intramedullary tumors are rare, comprising 3.5% of spinal metastasis. Most
metastatic spinal lesions (70%) are found at the thoracic level, 20% in lumbar
region and 10% in the cervical region. We report a rare biopsy proven case of
intramedullary spinal metastatic carcinoma with neuroendocrine differentiation
because of its unusual presentation, involving spine at multiple noncontiguous
levels, which appeared as irregular small nodules on MRI. The primary tumor was
most likely from occult primary in lung. Biopsy from the spinal lesion
established the diagnosis of metastatic carcinoma with neuroendocrine
differentiation. Therefore, in patients with spinal metastasis, a thorough work
up is advised to evaluate primary site. This would help to delineate the nature
and the extent of the systemic disease. We highlighted herein the clinical
presentation, radiological findings particularly MRI and role of biopsy in the
diagnosis and treatment of intramedullary spinal metastasis.