Giant intradural metastases of nonneurogenic origin involving multiple segments represent
an extremely rare manifestation of an unknown primary. The respective literature is
very scarce. We present a 45-year-old female with complaints of low back pain for
4 years, involuntary urination for 2 years, and difficulty in using both lower limbs
for 1 month. Examination revealed paraparesis with hypotonia. Imaging of lumbosacral
spine revealed that expansile lytic destruction of vertebral bodies and posterior
elements was noted from D8 to S2 vertebra and a large-sized patchy enhancing heterogeneous
intradural extramedullary lesion was noted in D8–S2 level. Decompressive laminectomy
from D11 to L4 vertebra and subtotal excision of the lesion were done. There was a
marked improvement in the lower limb weakness and low back pain postoperatively. Histopathology
revealed metastatic adenocarcinoma. Immunohistochemistry showed epithelial membrane
antigen positivity. Accordingly, the aim of the surgery is strictly palliative. The
majority of patients benefit with respect to neurological deficit/pain independent
of the extent of resection. Thus, decompressive surgery is recommended to increase
the quality of life. The occurrence of intradural spinal metastasis is rare. Only
few cases of intra dural spinal metastasis involving multiple cord segments and osteolytic
bony erosions have been documented. Hence this case is being presented here for its
rarity and its uniqueness.
Key-words:
Giant intradural metastasis - posterior decompression - unknown primary
