J Korean Orthop Assoc.  2010 Feb;45(1):78-82. 10.4055/jkoa.2010.45.1.78.

Intramedullary Spinal Cord Metastasis (ISCM) Arising from Small Cell Lung Cancer (SCLC)

• Kim SB
• Oh BH
• Cho SK
• Hwang CM
• Heo YM
• Jeon TS

• KMID: 2185598
• DOI: http://doi.org/10.4055/jkoa.2010.45.1.78

Abstract

Intramedullary spinal cord metastases occurring from any malignant tumor are usually accompanied by frequent metastases in the intracranium. The clinical features of this disease have been described as the rapid progression of neurologic deficit that can lead to complete paraplegia. In this case, the authors treated a 76-year-old woman, who was diagnosed with an intramedullary spinal cord metastasis arising from a small cell lung cancer without an invasion of the brain, with decompressive surgery and posterior instrumentation. The patient suffered from weakness of her legs, walking difficulties, and urinary and fecal incontinence. Her preoperative neurologic symptoms were improved significantly after surgery. The patient did not want to have further treatment for the primary cancer, and she died from pneumonia caused by aggravation of the underlying disease 3 months after surgery. We report this rare case, which was diagnosed as a metastasis of a small cell lung cancer postoperatively, with a review of the relevant literature.

Keyword

intramedullary spinal cord metastasis; small cell lung cancer

MeSH Terms

Aged
Brain
Fecal Incontinence
Female
Humans
Leg
Neoplasm Metastasis
Neurologic Manifestations
Paraplegia
Pneumonia
Small Cell Lung Carcinoma
Spinal Cord
Walking

Figure

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  Figure 1 CT scan of the chest showed huge mass on the left lower lung field, corresponding with small cell lung cancer (SCLC).

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  Figure 2 Preoperative MRI showed the tumor at the level of the conus medullaris. 1.5×1.3×1.4 cm sized round mass was compressing the spinal cord on the T2 weighted images. Well-marginated mass was seen on the enhanced T1 weighted images (A, T2 weighted sagittal; B, T1 weighted sagittal; C, Enhanced T1 weighted sagittal; D, T2 weighted axial; E, T1 weighted axial; F, Enhanced T1 weighted axial).

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  Figure 3 Intraoperative gross findings showed poorly marginated gray mass appeared in intramedullary portion after longitudinal incision on dura mater and arachnoid mater under microscopy.

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  Figure 4 Histologic findings showed typical features of small cell carcinoma. Microscopy showed diffuse infiltration of small round tumor cells with nuclear molding, scant cytoplasm and granular, dense chromatin on H&E stain (A, Hematoxyline & Eosin, ×400). The cytoplasm of tumor cells showed strong positivity on immunohistochemical stains with antibodies to neuroendocrine marker such as chromogranin (B, Chromogranin, ×400) and epithelial marker, EMA (C, Epithelial membrane antigen, ×400).

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