AN UNUSUAL NEURAXIS METASTASIS PRESENTATION

Metastatic cancer is a disease with an uncertain presentation as stated by miscellaneous research data. The incidence of this feature is still uncertain due to lack of case reports. The most common subtype of this form of metastasis is lung cancer, responsible for approximately 50% of all cases, followed by some less common malignancies such as breast cancer, prostate cancer, lymphoma, melanoma and renal cell carcinoma. The conus medullary metastasis is the least incident metastasis of the neuraxis topography. The malignancy arrival can occur through two main pathways: the arterial pathway and the intramedullary venous plexus pathway. The most common clinical presentation is pain related to the topography of the lesion, followed by loss of muscular force and sensitivity; the progression of the neurological symptoms generally occurs in the first month after the initiation of the symptoms. The diagnosis is estabelished through a spinal MRI, containing T1 and T2 sagital images and axial images of the affected vertebra plus imaging of two lower and upper vertebral segments. The spinal MRI is indicated in 48 hours after total loss of neurological function; the recovery of neurological function is virtually zero after this 48-hour period. The main treatment consists in surgical resection of the lesion and can be complemented or substituted by radiotherapy or chemotherapy depending on the patient's medical condition. The overall survival prognosis is reserved to those with multiple intramedullary lesions with or without associated encephalic lesions. This case report is about a 53 y.o, white female with primary breast cancer who underwent total mastectomy (pT2N1M0, positive hormonal receptor, Ki67- 20%) in 2008 associated with chemotherapy (AC regimen ×4 + tamoxifen) for 10 years. In June, 2018 the patient reported starting feeling dizziness symptoms. The patient then underwent a cranial CT in which a left cerebellar mass was found. The patient was referenced to a neurosurgery service in which she underwent a left cerebellar hemisphere resection. Anastrozol and CNS radiotherapy were indicated. Three months after the neurosurgical resection, the patient manifested symptoms of paresthesia and paresia in lower limbs rapidly progressing to paralysis. A new MRI identified a mass at T12/L1 level (conus medullaris level); the patient underwent surgical resection of the newly found mass with no improvement of her clinical condition. The patient died in December, 2018.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019