J Korean Soc Spine Surg.  2009 Jun;16(2):138-141. 10.4184/jkss.2009.16.2.138.

Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma : A Case Report

• Ha JW
• Park Y
• Kim SG
• Choi YJ
• Joo SH

• KMID: 2209609
• DOI: http://doi.org/10.4184/jkss.2009.16.2.138

Abstract

An intradural extramedullary metastasis to the spinal nerve root across dura mater is extremely rare. The authors encountered a case 39-year-old man who suffered radiculopathy arising from a soft mass around nerve root mimicking a nerve sheath tumor compressing the 4th lumbar nerve root in the right intervertebral foramen between the 4th and 5th lumbar spine. After an excisional biopsy, the metastatic infiltration of adenocarcinoma was confirmed pathologically. The primary lesion was found to be an intrahepatic cholangiocarcinoma with multiple metastases. This report suggests that an intradural metastatic tumor can show similar clinical and radiographic findings to other disease,s such as a nerve sheath tumor. The results also suggest that proper diagnosis and further treatment are possible only by pathological confirmation after and excisional biopsy.

Keyword

Spinal nerve; Intradural extramedullary metastasis; Cholangiocarcinoma

MeSH Terms

Adenocarcinoma
Adult
Biopsy
Cholangiocarcinoma
Dura Mater
Humans
Liver Neoplasms
Neoplasm Metastasis
Radiculopathy
Spinal Nerve Roots
Spinal Nerves
Spine
Cholangiocarcinoma
Cholangiocarcinoma
Liver Neoplasms

Figure

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  Fig. 1. Findings of Magnetic Resonance Imaging. A. Axial T2-weighted image (TR 3500/TE107) is showing a right-sided fusiform shaped spinal nerve root mass (arrow) with intermediate signal intensity compressing spinal nerve. B. Sagittal T1-weighted image (TR 300/TE 10) is showing isointense mass (arrow) enlarging intervertebral neural foramen. C-D. Contrast-enhanced T1-weighted fat suppression axial (TR 467/TE 10) and sagittal (TR 350/TE 9) images are showing highly enhancing mass (arrow) with internal cystic or necrotic portion.

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  Fig. 2. Diffuse infiltration of well-differentiated adenocarcinoma(white arrow) in nerve tissues & ganglions(black arrow) was noted.(H&E, ×200)

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  Fig. 3. Contrast-enhanced CT scan is showing a hypoattenuating irregular large cholangiocarcinoma (arrow) with peripheral rim enhancement (arrowheads) in left lobe of liver.

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