Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.72
Peer-review started: June 10, 2015
First decision: August 18, 2015
Revised: November 13, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: March 24, 2016
Processing time: 286 Days and 5.6 Hours
Intramedullary spinal cord tumors are rare. The improved survival resulting from more effective treatments for many cancers has led to an increased number of publications concerning intramedullary spinal cord metastasis (ISCM), including case reports and literature reviews; however, ISCM remains extremely rare in renal cancer. A 69-year-old man with a medical history of renal cell carcinoma (RCC) presented with urinary retention and bilateral paralysis of the lower extremities. A neurological examination revealed bilateral paraparesis below L1. Although brain magnetic resonance imaging (MRI), bone scintigraphy, and abdominal contrast-enhanced computed tomography revealed no abdominal findings, the thracolumbar MRI indicated a spot on the spinal cord at the Th12 level that exhibited hyperintensity on T2-weighted imaging and gadolinium diethylenetriaminepentaacetic acid enhancement on T1-weighted imaging. Accordingly, an ISCM of RCC was diagnosed. The patient rejected all treatments for these metastases except the steroid therapy. The patient’s condition deteriorated owing to metastatic progression, and he died 3 mo after the appearance of ISCM symptoms. The prognosis of this condition was poor. The mean survival durations were 8 mo with surgical treatment, 4 mo with irradiation, and 2 mo with palliative treatments. In cases involving neurological features and if brain or bone metastasis or spinal cord compression is not clearly observed, gadolinium-enhanced MRI should be performed to determine the existence of ISCM. Recently, some authors have reported the efficacy of ISCM resection. Surgical treatment could potentially yield improvements in the nervous symptoms or a longer survival after treatment. Although the prognosis was poor in most cases of ISCM, surgical treatment may improve the patient’s quality of life.
Core tip: Intramedullary spinal cord metastasis (ISCM) is extremely rare in renal cancer. A 69-year-old man with a medical history of renal cell carcinoma presented with urinary retention and bilateral paralysis of the lower extremities. A neurological examination revealed bilateral paraparesis below L1. ISCM of renal cell carcinoma was diagnosed via thracolumbar gadolinium-enhanced magnetic resonance imaging (MRI). In a case involving neurological features and if brain or bone metastasis or spinal cord compression is not clearly observed, gadolinium-enhanced MRI should be performed to reveal the existence of ISCM.