Presentation
Breast cancer. Now leg weakness.
Patient Data
The cord demonstrates florid leptomeningeal enhancement coating its entire length from upper cervical down to the presacral cul-de-sac. The degree of leptomeningeal enhancement progressively increases as one extends inferiorly and in the lower thoracic and lumbar canal the entire CSF space demonstrates contrast enhancement. As the lower sequences have been obtained after the cervical spine, some of this enhancement likely represents gadolinium leaking into the CSF space rather than necessarily complete solid encasement of the cauda equina. This notwithstanding, there is extensive high T2 signal throughout the majority of the cord, particularly in the lower cervical region, and in the conus.
Case Discussion
The patient had had an established diagnosis of breast cancer, and malignant cells were confirmed on CSF.
Breast biopsy
MICROSCOPIC DESCRIPTION: Sections show multiple cores of breast parenchyma which shows an invasive adenocarcinoma which is arranged in single cords and small nests. There is associated high grade in-situ carcinoma with focal areas of central necrosis.
- Estrogen receptor: POSITIVE Staining intensity strong % tumor cells >90
- Progesterone receptor: POSITIVE Staining intensity strong % tumor cells 10
- HER-2 score 2+
- ki67 25%
- E cadherin is negative in in situ and invasive carcinoma which support the diagnosis of invasive lobular carcinoma and pleomorphic lobular carcinoma in situ.
DIAGNOSIS: Invasive adenocarcinoma and high grade in-situ carcinoma.
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