J Korean Soc Spine Surg.  2005 Mar;12(1):83-86. 10.4184/jkss.2005.12.1.83.

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

• Ha KY
• Ryoo SJ
• Lee JS
• Cho YH

• KMID: 1897026
• DOI: http://doi.org/10.4184/jkss.2005.12.1.83

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.

Keyword

Rectal cancer; Metastasis; Distant; Intradural seeding

MeSH Terms

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

Figure

• 

  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).

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  Fig. 2. Followup 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 patho-logic 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).

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  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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