Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2005 Mar;12(1):83-86. Korean.
    Published online Mar 31, 2005.
    https://doi.org/10.4184/jkss.2005.12.1.83
    Copyright © 2005 Korean Society of Spine Surgery
    Case Report

    Distant Intradural Metastasis by Direct Seeding Through Dural Opening From the Metastasis of Rectal Cancer

    Kee-Yong Ha, M.D., Seung-Joon Ryoo, M.D., Jun-Seok Lee, M.D. and Yang-Ho Cho, M.D.
      • Department of Orthopedic Surgery, Kang-Nam St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea.
    • Address reprint requests to Kee-Yong Ha, M.D. Department of Orthopedic Surgery, Kang-Nam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Ban-Po Dong, Seo-Cho Ku, Seoul, 137-040 Korea. Tel: 82-2-590-1464, Fax: 82-2-535-9834, Email: kyh@cmc.cuk.ac.kr

    Abstract

    Few cases of intradural metastasis of a non-neurogenic origin, without antecedent cerebral metastasis, have been reported. To the best of our knowledge; however, this is the first reported case of distant tumor metastasis via seeding to the intradural space through a dural opening, which formed a tumor mass without antecedent brain metastasis at a different spine level. The medical records and imaging studies of a 67-year-old woman suffering from lower back pain and paresis of the lower extremities, were reviewed. She had previously had rectal cancer. A decompressive laminectomy and excision of the intradural mass were performed. The histopathology study confirmed her original diagnosis.

    Keywords
    Rectal cancer; Metastasis; Distant; Intradural seeding

    Figures

    Fig. 1
    Initial sagittal MRI

    (A) Metastatic tumor mass invading both pedicles, lamina, and vertebral body of L2 and compressing the thecal sac; (B) T2 weighted images showing metastatic tumor into the epidural space (arrow).

    Fig. 2
    Follow-up sagittal MRI (6 months later).

    (A) Large focal lesion occupying L1 to L4, both pedicles of L2, and spinal canal at L5 and S1. The MRI scan also shows the pathologic compression fracture at L2-L4. There was an extension of the original metastatic tumor mass into the epidural space due to the compression and displacement of the adjacent dural sac and cauda equina at L2-L3. The detached intradural tumor mass also compressed the cauda equina at L5-S1; (B) T2 weighted image showing metastatic tumor into the epidural space (arrow).

    Fig. 3
    Schematic figure of intradural metastasis.

    The original tumor mass adhered to the dura mater and compressed the conus medullaris at L2. Just below the tumor mass, the dura mater weakened, and an opening was formed. The distant tumor mass detached from the original metastatic tumor mass occurred at L5-S1 intradurally and compressed the cauda equina.

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    MeSH Terms
    Aged
    Brain
    Diagnosis
    Female
    Humans
    Laminectomy
    Low Back Pain
    Lower Extremity
    Medical Records
    Neoplasm Metastasis*
    Paresis
    Rectal Neoplasms*
    Spine
    Metrics
    Share
    Figures
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