Koyama Keita, Takahashi Hiroshi, Inoue Masahiro, Okawa Akihiko, Nakajima Arata, Sonobe Masato, Akatsu Yorikazu, Saito Junya, Taniguchi Shinji, Yamada Manabu, Yamamoto Keiichiro, Aoki Yasuchika, Furuya Takeo, Koda Masao, Yamazaki Masashi, Ohtori Seiji, Nakagawa Koichi
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan.
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba, 260-8677, Japan.
J Med Case Rep. 2019 Jul 20;13(1):220. doi: 10.1186/s13256-019-2155-z.
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.
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.
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.
硬脊膜内髓外脊髓转移是一种相对罕见的疾病。此外，很少有报告称硬脊膜内转移的初始表现为神经症状。我们报告一例以神经症状为初始表现，因乳腺癌转移至马尾神经的病例。
一名76岁的日本女性，既往身体健康，因双侧臀部和下肢剧痛就诊于我院，无任何受伤史。磁共振成像在L2/3水平发现一个孤立的硬脊膜内马尾神经肿块，我们最初怀疑是神经鞘瘤。由于疼痛剧烈，患者希望接受手术。然而，为评估患者一般状况而进行的胸部计算机断层扫描显示左侧疑似乳腺癌并伴有肺转移。因此，我们考虑马尾神经肿瘤为乳腺癌转移的可能性。我们实施了L1 - 3椎板切除术及肿瘤切除术。病理结果显示为腺癌。术后她的疼痛得到缓解，直至术后9个月去世，其状况一直良好。
仅根据磁共振成像结果难以明确马尾神经肿瘤是良性还是恶性。临床医生在计划进行硬脊膜内马尾神经肿瘤切除手术时应考虑转移的可能性。
