Tuberc Respir Dis.  2009 Dec;67(6):574-576.

Newly Developed Weakness of Lower Extremities Despite Improved Brain Metastasis of Lung Cancer after Radiotherapy

• Yang JH
• Jang YJ
• Ahn SJ
• Kim HR
• Kim CH
• Koh JS
• Choe DH
• Lee JC

Abstract

An intramedullary spinal cord metastasis (ISCM) rarely develops in systemic cancer but is indicative of a poor prognosis. A 56-year-old man was admitted due to weakness of the lower extremities. He had received radiotherapy 3 months prior for a brain metastasis that had developed 1 year after achieving a complete response from chemotherapy for extended stage small cell lung cancer. Although the brain lesion had improved partially, ISCM from the cervical to lumbar-sacral spinal cords, which was accompanied by a leptomeningeal dissemination, was diagnosed based on magnetic resonance imaging of the spine and cerebrospinal fluid cytology. Finally, he died of sudden cardiac arrest during treatment. This is the first case of ISCM involving the whole spinal segments. Physicians should be aware of the subsequent development of ISCM in lung cancer patients with a previously known brain metastasis who present with new neurological symptoms.

Keyword

Small Cell Lung Carcinoma; Neoplasm Metastasis; Spinal Cord

MeSH Terms

Brain
Death, Sudden, Cardiac
Humans
Lower Extremity
Lung
Lung Neoplasms
Magnetic Resonance Imaging
Middle Aged
Neoplasm Metastasis
Prognosis
Small Cell Lung Carcinoma
Spinal Cord
Spine

Figure

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  Figure 1 Multiple enhancing nodules with high signal intensity (arrows) on T2-weighted image of MRI were found over entire spinal cords from cervical spine to lumbar-sacral region.

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  Figure 2 Liquid based cytology preparation revealed metastatic small cell carcinoma clusters showing inconspicuous cytoplasm, hyperchromatic nuclei and nuclear molding (papanicolaou, ×400)

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  Figure 3 (A) 6 cm-sized heterogeneously enhancing mass involving right frontal, temporal lobe with peritumoral edema on brain MRI. (B) Remarkably reduced size of the metastatic mass 3 months after radiotherapy.

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