Ishibashi Y, Tokuchi Y, Kamachi M, Harada M, Isobe H
Department of Pulmonary Disease, National Sapporo Hospital, 4-2 Kikusui Shiroishiku Sapporoshi, Hokkaido, Japan.
Nihon Kokyuki Gakkai Zasshi. 2000 Dec;38(12):943-6.
The patient was a 54-year-old man who in May 1999 received a diagnosis of squamous cell carcinoma, T4 N2 M1, stage IV. Systemic chemotherapy and stereotactic radiosurgery were performed only to result in further progression of the disease. In August 1999, he experienced gait disturbance due to lumbar pain. Rehabilitation improved the gait disturbance and he was discharged. In October, since the pain reappeared and there was numbness in the right leg, he was readmitted. Brain MRI revealed multiple brain metastasis and whole brain irradiation was performed. But his symptoms deteriorated, and palsy of the right leg ensued. Later, bladder dysfunction also developed. Since spinal cord MRI revealed intramedullary metastasis at Th 12 and L1 levels, we performed radiotherapy for the lumbar medullary lesion, together with systemic chemotherapy. After chemoradiotherapy the tumor size decreased and the pain improved. Cases of lung cancer with intramedullary metastasis are rare, especially those diagnosed before death.
患者为一名54岁男性，于1999年5月被诊断为鳞状细胞癌，T4 N2 M1，IV期。仅进行了全身化疗和立体定向放射外科治疗，但疾病仍进一步进展。1999年8月，他因腰痛出现步态障碍。康复治疗改善了步态障碍，随后出院。10月，由于疼痛再次出现且右腿麻木，他再次入院。脑部MRI显示多发脑转移，遂进行了全脑照射。但他的症状恶化，随后出现右腿麻痹。后来还出现了膀胱功能障碍。由于脊髓MRI显示胸12和腰1水平髓内转移，我们对腰椎髓内病变进行了放疗，并联合全身化疗。放化疗后肿瘤体积缩小，疼痛改善。肺癌发生髓内转移的病例罕见，尤其是在死亡前确诊的病例。
