Lung adenocarcinoma presenting as intramedullary spinal cord metastasis: Case report and review of literature

Authors

Neil Majmundar, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, United States. Electronic address: majmunne@njms.rutgers.edu.Follow
Belinda Shao, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, United States. Electronic address: belinda.shao@njms.rutgers.edu.
Rachid Assina, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, United States. Electronic address: assinara@njms.rutgers.edu.

Document Type

Article

Abstract

Intramedullary spinal cord metastasis (IMSCM) is a rare entity which lacks well-defined treatment guidelines, yet sees rising incidence. We report a case of a 67-year-old man who presented with severe neck pain and numbness in his right fourth and fifth digits, and was found to have a C5-7 IMSCM of previously unknown lung adenocarcinoma. He underwent gross total resection of the IMSCM, afatinib, and radiation treatment. He had full reversal of his pain and sensory deficit, and remained ambulatory without any focal neurological deficit. Additionally, we conducted a literature review of original case series of IMSCM published between 1983 and 2016, representing 138 unique cases, and discuss various treatments with a focus on surgical resection and general treatment of stage IV lung adenocarcinoma. 18.75% of cases of IMSCM were an initial presentation of underlying malignancy. Rapidly progressive pain and weakness was the most common presentation, often compromising ambulatory status. Median survival ranged from 3.8 to 11.6 months after treatment in patients who were deceased at time of publication. Treatments included corticosteroids, chemotherapy, various radiotherapies, and surgical resection. Surgical resection was found to greatly improve symptoms and preserve ambulatory status, and was associated with increased survival time up to double that of non-surgical treatments. Most authors recommended surgical resection only in symptomatic patients with reversible deficits, to palliate symptoms and preserve ambulation. IMSCM can herald an underlying malignancy, and surgical resection can preserve ambulatory status and palliate symptoms as well increase survival time in a subset of patients.

Medical Subject Headings

Adenocarcinoma (secondary); Adenocarcinoma of Lung; Aged; Humans; Lung Neoplasms (secondary); Male; Spinal Cord Neoplasms (secondary)

Publication Date

6-1-2018

Publication Title

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

E-ISSN

1532-2653

Volume

52

First Page

124

Last Page

131

PubMed ID

29631755

Digital Object Identifier (DOI)

10.1016/j.jocn.2018.03.030

Recommended Citation

Majmundar, Neil; Shao, Belinda; and Assina, Rachid, "Lung adenocarcinoma presenting as intramedullary spinal cord metastasis: Case report and review of literature" (2018). Neurosurgery. 2211.
https://scholar.barrowneuro.org/neurosurgery/2211