Intradural metastasis to the cauda equina found as the initial presentation of breast cancer: a case report.

Abstract

BACKGROUND:

Intradural extramedullary spinal metastasis is a relatively rare condition. Furthermore, there are few reports with the initial presentation being a neurological symptom from an intradural metastasis. We report a case of a patient with metastasis to the cauda equina from breast cancer found due to neurological symptoms as the initial presentation.

CASE PRESENTATION:

A 76-year-old Japanese woman who was previously healthy presented to our hospital with bilateral severe buttock and lower extremity pain without any history of injury. A solitary intradural cauda equina mass was found by magnetic resonance imaging at the L2/3 level, and we suspected a schwannoma initially. The patient hoped to undergo surgery due to the severe pain. However, the chest computed tomographic scan obtained to assess the patient's general status showed the suspected breast cancer of the left side and a lung metastasis. Hence, we considered the possibility of cauda equina tumor metastatic from the breast cancer. We performed an L1-3 laminectomy and tumor extirpation. The pathology revealed adenocarcinoma. After surgery, she had relief from pain, and her status remained satisfactory until she died 9 months after surgery.

CONCLUSIONS:

It is difficult to clarify whether the cauda equina tumor is benign or malignant based only on Magnetic resonance imaging findings. Clinicians should consider the possibility of metastasis when planning the surgery for intradural cauda equina tumor extirpation.

• Authors: Keita Koyama, Hiroshi Takahashi, Masahiro Inoue, Akihiko Okawa, Arata Nakajima, Masato Sonobe, Yorikazu Akatsu, Junya Saito, Shinji Taniguchi, Manabu Yamada, Keiichiro Yamamoto, Yasuchika Aoki, Takeo Furuya, Masao Koda, Masashi Yamazaki, Seiji Ohtori, Koichi Nakagawa
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 13 Issue 1 Pg. 220 (Jul 20 2019) ISSN: 1752-1947 [Electronic] England
• PMID: 31324210 (Publication Type: Case Reports, Journal Article)

Topics

• Adenocarcinoma (diagnostic imaging, pathology, secondary)
• Aged
• Breast Neoplasms (diagnostic imaging, pathology)
• Cauda Equina (pathology, surgery)
• Fatal Outcome
• Female
• Humans
• Magnetic Resonance Imaging
• Spinal Cord Neoplasms (diagnostic imaging, pathology, secondary, surgery)
• Tomography, X-Ray Computed