Department of Neurosurgery, Cork University Hospital, Cork, Ireland; Edith and Loyal Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Centre, Phoenix, Arizona, USA.
Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
World Neurosurg. 2020 Nov;143:147-151. doi: 10.1016/j.wneu.2020.07.141. Epub 2020 Jul 27.
Spinal renal cell metastases are a common insidious pathological manifestation of the oncological process but less common are intramedullary and intraneural spinal metastases. The differential diagnosis of such pathological features can be difficult in the presence of conflicting radiological evidence.
In the present case report, we have detailed the clinical, diagnostic, surgical, and therapeutic progression of a 54-year-old man diagnosed with metastatic renal cell carcinoma. After the initial presentation and treatment, he had presented with symptomatic right lower limb radiculopathy. Magnetic resonance imaging identified a well-defined cystic lesion expanding in the right exit foramina at L5-S1, suggestive of a benign schwannoma. After a multidisciplinary review, he was treated symptomatically and imaging surveillance for a 19-month period, with static lesion findings. Failure of symptomatic management resulted in operative intervention and subsequent histological diagnosis of the metastatic deposit.
To the best of our knowledge, the present report is the first documented case of intraneural metastatic deposits from renal cell carcinoma that showed benign radiographic features and demonstrated a stable appearance on surveillance imaging studies for a significant period. These findings suggest that clinicians should have a high index of suspicion for a metastatic process in symptomatic patients with a known renal cell cancer regardless of the lesion's radiographic or temporal characteristics.
脊柱肾细胞转移是肿瘤过程中常见的隐匿性病理表现，但较少见的是脊髓内和神经内脊柱转移。在存在相互矛盾的放射学证据的情况下，对这种病理特征的鉴别诊断可能很困难。
在本病例报告中，我们详细描述了一名 54 岁男性转移性肾细胞癌的临床、诊断、手术和治疗进展。在最初的表现和治疗后，他出现了右侧下肢神经根病的症状。磁共振成像（MRI）发现 L5-S1 右侧出口孔处有一个界限清楚的囊性病变，提示为良性神经鞘瘤。经过多学科讨论，他接受了对症治疗和 19 个月的影像学监测，病变无变化。症状管理失败导致手术干预，随后的组织学诊断为转移性病灶。
据我们所知，本报告首次记录了一例来自肾细胞癌的神经内转移性病灶，其具有良性的影像学特征，并在相当长的时间内通过影像学监测研究显示出稳定的表现。这些发现表明，对于有已知肾细胞癌的症状性患者，无论病变的影像学或时间特征如何，临床医生都应高度怀疑转移过程。
