Abstract
In this case report, we describe an uncommon case of neuroendocrine cancer of unknown origin began with cauda equina syndrome in a patient affected by Paget disease of bone (PDB). A 76-year-old man with diagnosis of PDB, without history of pain or bone deformity, developed sudden severe low back pain. Bone alkaline phosphatase was increased and MRI and whole-body scintigraphy confirmed the localization of the disease at the third vertebra of the lumbar spine. Treatment with Neridronic Acid was started, but after only 2 weeks of therapy anuria and bowel occlusion occurred together with lower limb weakness and walking impairment. Cauda equina syndrome consequent to spinal stenosis at the level of L2–L3 was diagnosed after admission to Emergency Department and the patient underwent neurosurgery for spinal medulla decompression. The histologic results showed a complete subversion of bone structure in neoplastic tissue, consistent with metastatic neuroendocrine carcinoma of unknown origin. In conclusion, low back pain in the elderly may require deep investigation to individuate rare diseases. In asymptomatic patients with apparently stable PDB, the sudden appearance of pain or neurologic symptoms may alert the clinician for the possibility of other superimposing diseases, like bone metastases.
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SIB wrote the first draft of the manuscript and contributed to the patient management. OL contributed to the writing of the manuscript. EF and NN contributed to the management of the patients and revised the manuscript. GL and SB provide additional radiologic consultation. RS was responsible for patient management and for the writing of the manuscript. All authors revised the manuscript and agreed to the final submitted version.
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Silvia Irina Briganti, Oreste Lanza, Elvira Fioriti, Gaetano Leto, Sofia Battisti, Nicola Napoli, and Rocky Strollo declare no competing interests (financial or non-financial interests) that are directly or indirectly related to the work.
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Briganti, S.I., Lanza, O., Fioriti, E. et al. Paget Disease of Bone Harboring Bone Metastatic Neuroendocrine Cancer: A Case Report. Calcif Tissue Int (2024). https://doi.org/10.1007/s00223-024-01195-3
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DOI: https://doi.org/10.1007/s00223-024-01195-3