Chang Ying-Hsin, Lin Wei-Hao
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Ann Med Surg (Lond). 2025 May 12;87(6):3984-3987. doi: 10.1097/MS9.0000000000003341. eCollection 2025 Jun.
Pulmonary pleomorphic carcinoma (PC) is a rare and aggressive subtype of lung cancer. To date, spinal cord metastasis from pulmonary PC has not been reported.
A 67-year-old woman was diagnosed with left upper lobe (LUL) lung tumor, and surgical pathology confirmed PC with spindle and giant cell components. Following surgery, she developed progressive paraparesis with ascending hypesthesia. Contrast-enhanced cervicothoracic spine MRI revealed direct invasion of the T1-T3 vertebrae and pedicles by the LUL tumor, resulting in spinal cord compression and paraspinal muscle involvement. Neurogenic shock subsequently developed, and the patient died 2 weeks later.
Pulmonary PC is associated with a poorer prognosis than other non-small cell lung carcinomas. While it commonly metastasizes to the brain, bones, and liver, spinal cord involvement is exceedingly rare. Such metastasis can result in acute paraplegia, incontinence, and neurogenic shock, which increase mortality and lead to severe complications.
Although spinal cord metastasis is extremely rare in pulmonary PC, clinicians should maintain a high index of suspicion in patients presenting with new-onset neurological symptoms. Early MRI evaluation is crucial for prompt diagnosis and management, potentially improving outcomes and avoiding life-threatening complications.
肺多形性癌（PC）是一种罕见且侵袭性强的肺癌亚型。迄今为止，尚未有肺PC脊髓转移的报道。
一名67岁女性被诊断为左上叶（LUL）肺肿瘤，手术病理证实为具有梭形和巨细胞成分的PC。手术后，她出现进行性双下肢轻瘫并伴有感觉减退。颈椎胸椎增强磁共振成像（MRI）显示LUL肿瘤直接侵犯T1 - T3椎体和椎弓根，导致脊髓受压和椎旁肌肉受累。随后发生神经源性休克，患者在2周后死亡。
肺PC的预后比其他非小细胞肺癌更差。虽然它通常转移至脑、骨和肝，但脊髓受累极为罕见。这种转移可导致急性截瘫、尿失禁和神经源性休克，增加死亡率并导致严重并发症。
尽管肺PC脊髓转移极为罕见，但临床医生对出现新发神经系统症状的患者应保持高度怀疑。早期MRI评估对于及时诊断和治疗至关重要，可能改善预后并避免危及生命的并发症。
