Intramedullary spinal cord metastasis of gastric cancer

Abstract

The incidence of intramedullary spinal cord metastasis (ISCM) has been increasing because the overall survival of patients with cancer has improved thanks to recent advanced therapies, such as molecular targeted drugs, anticancer agents, and various irradiation techniques. ISCM from lung and breast cancer is the most common form among cases of ISCM. We report an extremely rare form of ISCM from gastric cancer. This 83-year-old man who had a past medical history of gastric adenocarcinoma presented with acute onset of paraparesis. Spinal magnetic resonance imaging revealed an intramedullary lesion at the upper thoracic level. Due to rapid worsening of his paresis, we decided to perform tumor extirpation. Gross total resection of the tumor was successfully performed. Pathological examination revealed poorly differentiated adenocarcinoma, suggesting the diagnosis of ISCM from gastric cancer. He demonstrated gradual improvement of paraparesis soon after surgery, although his overall survival was limited to about 6 months after surgery. When examining the etiology of acute paraparesis in elderly patients with a past medical history of cancer, ISCM should be considered in the differential diagnosis. The prognosis of ISCM from gastric cancer is still extremely limited. Unfortunately, there is currently no treatment with proven efficacy. Surgery for ISCM from gastric cancer, although a challenging procedure for spine surgeons, should be considered as a therapeutic option in these patients.

Nonbrain metastases seen on magnetic resonance imaging during metastatic brain tumor screening

“…The prevalence of ISCM has been reported to be 2.1% in an autopsy series of patients with cancer [ 53 , 54 ] and accounts for 1–3% of intramedullary spinal cord neoplasms [ 55 ]. With increasing morbidity of cancer and prolonged patient survival, the incidence of ISCM appears to be increasing [ 52 ].…”

“…With increasing morbidity of cancer and prolonged patient survival, the incidence of ISCM appears to be increasing [ 52 ]. Lung and breast cancers are the most common primary site and require special attention [ 52 , 54 , 55 ].…”

Intramedullary spinal cord metastases: current state of the problem

“…Лучевая терапия. На сегодняшний день лучевая терапия стала одним из основных методов лечения пациентов с ISCM [11,[29][30][31][32], позволяя во многих случаях добиться локального контроля. Так, A. Veeravagu и соавт.…”

“…У пациентов с быстро развивающимися симптомами сдавления спинного мозга стероиды могут быстро облегчить боль и отсрочить неврологическое ухудшение, уменьшая местный отек тканей и способствуя нормализации функции гематоспинального барьера, не влияя на выживаемость. В настоящее время при ISCM стероиды обычно сочетают с другими методами лечения [3,8,10,32,35].…”

“…Иммунотерапия служит достаточно перспективным методом лечения в онкологии [32]. Существуют данные о случаях полного и частичного регресса ИММ немелкоклеточного рака легких при использовании ниволумаба [38].…”