Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report

Abstract

Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system.

Case Report A male adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, a metastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital.

Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part in maintaining the performance and the quality of life of the patient.

Resumo

Objetivo Relatar um caso de metástase intradural extramedular de um carcinoma renal. Metástases nesta topografia são de baixa ocorrência, ainda mais tratando-se de um tumor primário no sistema urinário.

Relato de caso Paciente adulto do sexo masculino que inicia quadro de dor nos membros inferiores, evoluindo com paraparesia crural, tem piora do quadro, acometendo a função esfincteriana. O paciente possuía um histórico prévio de nefrectomia por neoplasia maligna em sítio renal. Após investigação com exames complementares, foi detectada a lesão metastática responsável pelos sintomas. A mesma foi tratada cirurgicamente pela equipe de neurocirurgia do serviço.

Conclusão Casos como este não são comuns e nem sempre nos levam a aventar a hipótese de metástase nesta topografia, frente à baixa incidência e ao início de sintomas muitas vezes inespecíficos, como dor. O tratamento, apesar de paliativo, tem um papel importante na qualidade de sobrevida do paciente.

Keywords

neoplasm metastasis - kidney neoplasms - intradural metastasis

Palavras-chave

metástase neoplásica - neoplasias renais - metástases intradurais

• References

• 1 Joaquim AF, Ghizoni E, Tedeschi H, Pereira EB, Giacomini LA. Radiocirurgia estereotáxica para metástases de coluna vertebral: revisão de literatura. Einstein (Sao Paulo) 2013; 11 (02) 247-255
• 2 Sciubba DM, Petteys RJ, Dekutoski MB. , et al. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 2010; 13 (01) 94-108
• 3 Prevedello DMS, Koerbel A, Tatsui CE. , et al. Fatores prognósticos no tratamento dos tumores intradurais extramedulares: estudo de 44 casos. Arq Neuropsiquiatr 2003; 61 (2A): 241-247
• 4 Araujo JLV, Veiga JCE, Figueiredo EG, Barboza VR, Daniel JW, Panagopoulos AT. Manejo das neoplasias metastáticas da coluna vertebral - uma atualização. Rev Col Bras Cir 2013; 40 (06) 508-514
• 5 Perrin RG, Livingston KE, Aarabi B. Intradural extramedullary spinal metastasis. A report of 10 cases. J Neurosurg 1982; 56 (06) 835-837
• 6 Akhavan A, Mehrabaniyan MR, Jarahi M, Navabii H. Intradural extramedullary metastasis from papillary carcinoma of thyroid. BMJ Case Rep 2012; 2012: x
• 7 Santos VG, Cavalcante RAC, Marques RAS, Zaccariotti VA. Metástase espinhal intradural e extramedular: relato de caso. Arq Bras Neurocir 2015; 34 (03) 229-231
• 8 Frey I, Le Breton C, Lefkopoulos A. , et al. Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Eur Radiol 1998; 8 (07) 1187-1192
• 9 Capek S, Krauss WE, Amrami KK, Parisi JE, Spinner RJ. Perineural Spread of Renal Cell Carcinoma: A Case Illustration with a Proposed Anatomic Mechanism and a Review of the Literature. World Neurosurg 2016; 89: 728.e11-728.e17
• 10 Kim D-Y, Lee J-K, Moon S-J, Kim S-C, Kim C-S. Intradural spinal metastasis to the cauda equina in renal cell carcinoma: a case report and review of the literature. Spine 2009; 34 (24) E892-E895
• 11 Wu J, Zheng W, Xiao J-R, Sun X, Liu W-Z, Guo Q. Health-related quality of life in patients with spinal metastases treated with or without spinal surgery: a prospective, longitudinal study. Cancer 2010; 116 (16) 3875-3882
• 12 Wolf A, Johnstone R, Siddiqi F. Intradural Extramedullary Spinal Cord Metastasis of the Prostate: A Case Presentation and Review of the Literature. Can J Neurol Sci 2016; 43 (04) 588-592
• 13 Purvis TE, Goodwin CR, Lubelski D, Laufer I, Sciubba DM. Review of stereotactic radiosurgery for intradural spine tumors. CNS Oncol 2017; 6 (02) 131-138