Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2010 Feb;45(1):78-82. Korean.
    Published online Feb 28, 2010.
    https://doi.org/10.4055/jkoa.2010.45.1.78
    Copyright © 2010 by The Korean Orthopaedic Association
    Case Report

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

    Sang-Bum Kim, M.D., Byung-Hak Oh, M.D., Seong-Kwon Cho, M.D., Cheol-Mog Hwang, M.D.,* Youn-Moo Heo, M.D. and Taek-Soo Jeon, M.D.†
      • Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
      • *Department of Radiology, Konyang University College of Medicine, Daejeon, Korea.
      • †Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Hospital, Busan, Korea.
    • Correspondence to: Taek-Soo Jeon, M.D. Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Hospital, #1435, Jwa-dong, Haeundae-gu, Busan 612-030, Korea. TEL: +82-42-600-6937, FAX: +82-42-545-2373, Email: sirjeon@kyuh.co.kr
    Received February 09, 2009; Accepted August 22, 2009.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    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.

    Keywords
    intramedullary spinal cord metastasis; small cell lung cancer

    Figures

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

    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).

    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.

    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).

    References

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