Gibas Barbara Helena, Teodorczyk Jacek, Cytawa Wojciech, Bandura Artur
Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland.
Indian J Nucl Med. 2025 Mar-Apr;40(2):92-94. doi: 10.4103/ijnm.ijnm_107_24. Epub 2025 Jun 27.
Intramedullary cauda equina metastases (ICEM) are rare lesions in patients with malignant tumors, accounting for <1% of all metastatic sites. We present a history of a 65-year-old female who achieved long disease-free survival (DFS) after local treatment of ICEM in the course of oligometastatic lung adenocarcinoma. More than 2 years after initial treatment (pneumonectomy and lymphadenectomy), the disease recurred with a single lesion in the contralateral lung. Stereotactic body radiation therapy (SBRT) guided by F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) resulted in a complete metabolic response of the lung metastasis. Soon thereafter, the patient was diagnosed with hypopituitarism, and the magnetic resonance imaging (MRI) and FDG PET/CT revealed the presence of a focal lesion in the sella turcica, highly suspicious for metastatic pituitary adenocarcinoma. Again, the lesion was successfully treated with SBRT. After another year of follow-up, the patient developed low back pain accompanied by urine incontinence. MRI revealed a focal lesion in S2, which was resected and confirmed as adenocarcinoma metastasis. The following FDG PET/CT guided the adjuvant radiotherapy of the residual disease in the S1/S2 region. The DFS has so far reached over 24 months.
髓内马尾转移瘤（ICEM）在恶性肿瘤患者中是罕见病变，占所有转移部位的比例不到1%。我们报告了一名65岁女性的病史，她在寡转移肺腺癌病程中对ICEM进行局部治疗后实现了长期无病生存（DFS）。初始治疗（肺切除术和淋巴结清扫术）两年多后，疾病复发，对侧肺出现单个病灶。在F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）引导下的立体定向体部放射治疗（SBRT）使肺转移灶出现完全代谢缓解。此后不久，患者被诊断为垂体功能减退，磁共振成像（MRI）和FDG PET/CT显示蝶鞍区存在一个局灶性病变，高度怀疑为转移性垂体腺癌。该病灶再次通过SBRT成功治疗。经过又一年的随访，患者出现腰痛伴尿失禁。MRI显示S2有一个局灶性病变，切除后确诊为腺癌转移。随后的FDG PET/CT引导了S1/S2区域残留病灶的辅助放疗。迄今为止，DFS已超过24个月。
