Spinal cord metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Increasing numbness, paresthesia and weakness of the lower limbs increasing over past month.

Patient Data

Age: 55 years
Gender: Female
Modality: MRI

 The well defined 1 cm ovoid intra-medullary lesion located just above the conus at the level of T12-L1 shows ring enhancement post contrast. There is associated mild expansion. The predominantly central, markedly hyperintense signal on T2 weighted scans without corresponding axial T1 hypo-intensity seen within conus and extending superiorly to the distal thoracic cord up to the level of T2 is also associated with mild cord expansion. The cervical cord is spared allowing for 3T artefact. No abnormal flow voids or enhancing vessels around the cord. No definite abnormal leptomeningeal enhancement. 

A spiculated mass measuring up to 3 cm in the right upper lobe of lung. A 5 mm nodule is also present in the left upper lobe of lung.

Modality: Annotated image

A vividly enhancing ring intramedullary lesion (blue arrow) is present within the conus with extensive cord oedema above and below (yellow arrows). 

Best seen on axial T1 C+ images is a sizeable pulmonary mass (blue dotted line). 

Modality: CT

A 27 mm diameter spiculated nodule is present in the region of the anterior segment of the right upper lobe. No definite left upper lobe pulmonary nodule is seen.  No  significant hilar/mediastinal lymphadenopathy is identified. Minor bibasal fibrosis is noted.  No gross bony destructive lesion is seen. 

The patient went on to have a laminectomy and excision of the mass. 

Histology

MICROSCOPIC DESCRIPTION: The sections show multiple small fragments which are composed of moderately atypical cells.  These have round, oval and angulated hyperchromatic nuclei and a variable amount of pale cytoplasm and are arranged in small solid islands within a fibrous stroma.  Scattered mitotic figures are noted.  An occasional poorly formed glandular structure is also identified.  The features are of metastatic undifferentiated carcinoma and are most consistent with an origin from lung. 

Tumour cells show strong nuclear immunostaining for TTF-1 and strong cytoplasmic staining for BerEp4, CK7 and cytokeratin AE1/AE3. No staining for CK20 is seen. This immunohistochemical profile indicates an origin from lung.

FINAL DIAGNOSIS: Spinal cord metastatic undifferentiated carcinoma with features consistent with an origin from lung.

Case Discussion

Although metastases are an uncommon intramedullary spinal cord tumour, they are sometimes encountered as the presenting complaint. This case also demonstrates the need to review the margins of the films for unexpected lesions. 

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Case Information

rID: 19502
Case created: 16th Sep 2012
Last edited: 19th Mar 2017
Tag: spine
Inclusion in quiz mode: Included

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