Korean J Spine.  2017 Mar;14(1):11-13. 10.14245/kjs.2017.14.1.11.

Delayed Epidural Mucin Collection after Surgery for Spinal Metastatic Pancreatic Adenocarcinoma

• Kim DH
• Kim DH
• Kim HS
• Nam KH
• Choi BK
• Han IH

• KMID: 2377782
• DOI: http://doi.org/10.14245/kjs.2017.14.1.11

Abstract

A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper-thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography. Radiotherapy for spinal metastasis and subsequent chemotherapy was carried out. Sixteen months after pancreatectomy, gait disturbance occurred and follow-up thoracic magnetic resonance imaging (MRI) showed aggravation of metastasis at T2 and T4 compressing the spinal cord. We performed a decompressive laminectomy with subtotal resection of the tumor masses and pedicle screw fixation at C7-T6. Neurologic status improved after the operation. Histopathologic examinations revealed the tumor as metastatic mucin producing adenocarcinoma. Three months after surgery, motor weakness and pain was reappeared. MRI showed large amount of epidural fluid collection. We performed wound revision and there was large amount of gelatinous fluid at the epidural space. We suggest that postoperative mucin collection and wound problems should be considered after surgery for mucin producing metastatic pancreatic tumor.

Keyword

Spinal neoplasm; Neoplasm metastasis; Mucins; Adenocarcinoma

MeSH Terms

Adenocarcinoma*
Aged
Back Pain
Drug Therapy
Electrons
Epidural Space
Follow-Up Studies
Gait
Gelatin
Humans
Laminectomy
Magnetic Resonance Imaging
Mucins*
Neoplasm Metastasis
Neurologic Manifestations
Pancreas
Pancreatectomy
Pancreatic Neoplasms
Pedicle Screws
Radiotherapy
Spinal Cord
Spinal Neoplasms
Thorax
Wounds and Injuries
Gelatin
Mucins