• Daniel J Donovan and Judy H Freeman.
• Neurosurgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. donovand001@hawaii.rr.com
• Spine. 2006 Jun 15; 31 (14): E460-3.

Study DesignWe present the case of a patient with a solitary neoplasm of the intramedullary spinal cord.ObjectiveThe tumor caused findings of Brown-Séquard syndrome and was the initial presentation of widely metastatic renal cell carcinoma (RCC).Summary Of Background DataMetastasis of the intramedullary spinal cord has been uncommonly reported and is extremely rare as the initial sign of a disseminated carcinoma.MethodsThe tumor was resected, and the patient's neurologic deficits slowly improved. The histopathology suggested an epithelioid neoplasm. However, despite expert review, the diagnosis was nonspecific, and the tumor appeared benign.ResultsIt soon recurred in the spinal cord, and repeat imaging studies showed numerous new metastases and a primary renal neoplasm. Biopsy and a repeat histopathologic analysis confirmed RCC, and the patient died of disseminated disease within another 2 months.ConclusionsDespite being uncommon, spinal cord metastases should be considered in some patients before surgery because it may expedite diagnosis, mitigate the need for surgery, and improve the quality of life for these patients. Clinical factors suggesting metastasis include a personal or family history of malignancy or conditions predisposing to it, the presence of multiple tumors in the spinal cord or elsewhere, nonspecific constitutional symptoms, such as weight loss or decreased appetite, and, specifically for RCC, an abnormally increased hematocrit.

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