J Korean Med Sci.  2013 Aug;28(8):1253-1256. 10.3346/jkms.2013.28.8.1253.

Intramedullary Spinal Cord Metastasis in Renal Cell Carcinoma: A Case Report of the Surgical Experience

• Park J
• Chung SW
• Kim KT
• Cho DC
• Hwang JH
• Sung JK
• Lee D

• KMID: 1793035
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1253

Abstract

Intramedullary spinal cord metastasis (ISCM) from renal cell carcinoma (RCC) is rare manifestation and most of them are treated by adjuvant treatment modalities like radiotherapy. Despite the radio-resistance of RCC itself, focal radiotherapy has been preferred as the first-line treatment modality of ISCM from RCC and only a few cases underwent surgical treatment. We describe a case of ISCM from RCC, which underwent surgical excision and pathologically confirmed. A 44-yr-old man was presented with rapid deterioration of motor weakness during focal radiotherapy for ISCM from RCC. After the surgery for removal of the tumor mass and spinal cord decompression, his motor power was dramatically improved to ambulate by himself. We report the first published Korean case of ISCM from RCC confirmed pathologically and describe our surgical experience and his clinical characteristics.

Keyword

Intramedullary Spinal Cord Neoplasm; Metastasis; Renal Cell Carcinoma

MeSH Terms

Adult
Carcinoma, Renal Cell/*diagnosis/pathology/surgery
Humans
Immunohistochemistry
Keratins/metabolism
Magnetic Resonance Imaging
Male
Motor Activity/physiology
Spinal Cord Neoplasms/pathology/secondary/*surgery
Tomography, X-Ray Computed
Treatment Outcome
Vimentin/metabolism
Keratins
Vimentin

Figure

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  Fig. 1 Initial CT images of the patient. (A and B) Abdominal CT revealed a left renal cell carcinoma (arrow). (C) CT scan also revealed nodular metastasis on lung field (arrow).

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  Fig. 2 Pre-operative T2-weighted and gadolinium enhanced T1-weighted lumbar MRI in the patient. (A) A T2-weighted MRI revealed increased T2 signal intensity (arrow) on T12 level and extensive edematous infiltration on intramedullary space. (B) Mass lesion (arrow) showed significant rim enhancement after gadolinium based contrast agent injection.

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  Fig. 3 Follow up MRI imaging after 2 months later from surgery. (A) A T2-weighted MRI (magnetic resonance image) revealed reduced both mass size and edematous infiltration on intramedullary space. (B) Tumor size was significantly reduced after gadolinium based contrast agent injection.

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  Fig. 4 Histopathologic and immunohistochemical staining findings for metastatic renal cell carcinoma. (A) The mass is composed of nests of clear tumor cells with intermediate nuclear grade and vascular meshwork (H&E stain, × 400). (B) Immunohistochemical staining for cytokeratin (C) and vimentin show a strong cytoplasmic reaction within tumor cells (× 400).

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