Intramedullary spinal cord metastasis: report of a case and review of the literature.

Intramedullary spinal cord metastasis (ISM) is an unusual cause of myelopathy, in comparison to the common problem of extramedullary metastasis. Most patients with ISM are found at autopsy. When patients with ISM are diagnosed premorbidly, they usually have a previously known or concurrently diagnosable primary neoplasm. Radiation therapy is the definitive therapy. We recently encountered a patient who was seen initially because of progressive myelopathy, without evidence of underlying malignancy, in whom a papillary carcinoma was found at myelotomy. The condition improved after surgery and the patient returned to his previous work for five months. Subsequently, a lesion histologically identical with that obtained from the previous myelotomy was found in the lung. This case illustrates the value of surgical intervention in selected situation. When there is no identifiable organ metastasis or multiple intramedullary lesions, radical microsurgical resection of a focal intramedullary lesion should be considered.