Abstract
Intramedullary spinal cord metastases (ISCM) are usually the result of rapidly progressing systemic cancer. Breast cancer represents one of the most common solid tumors associated with the development of ISCM at rather advanced stages of disease. In the present report we describe four new cases with advanced breast cancer developing ISCM. All cases presented herein indicated that ISCM is a late manifestation of disseminated breast cancer. Three of these patients had been treated for approximately 1–3 years for metastatic disease. Once ISCM developed, concurrent asymptomatic brain metastases were detected in one case, concurrent symptomatic brain disease (cerebellar) was present at the time of cervical ISCM diagnosis in another patient, and in another case, ISCM developed metachronously at 18 months after the diagnosis of symptomatic brain metastases treated by whole brain radiotherapy. One of these cases had brain metastases at presentation, while at relapse developed leptomeningeal carcinomatosis treated successfully, but followed shortly, as a terminal event, by ISCM and parenchymal brain recurrence.
All but one patient experienced a rather rapidly evolving disease course leading to death after 2–5 months from widespread neuraxis dissemination of their cancer, while one patient is still alive 6 months after the diagnosis of ISCM. All four cases, added to the list of the anecdotally reported cases of ISCM after breast cancer, undermine the ominous prognosis and limited treatment options available for this disease manifestation, and an extensive literature review and discussion of similar cases is provided.
Similar content being viewed by others
References
A Potti M Abdel-Raheem R Levitt DA Schell SA Mehdi (2001) ArticleTitleIntramedullary spinal cord metastases (ISCM) and non-small cell lung carcinoma (NSCLC): clinical patterns, diagnosis and theurapeutic considerations Lung Cancer 31 319–323
K Schwechheimer JM Lemminger (1985) ArticleTitleIntramedullary metastases: report of 4 cases and report of the literature Clin Neuropathol 4 28–37
KD Bappon A Hirano S Araki (1959) ArticleTitleExperiences with metastatic neoplasms involving the spinal cord Neurology 9 91
D Schiff BP O’Neill (1996) ArticleTitleIntramedullary spinal cord metastases: clinical features and treatment outcome Neurology 47 906–912
R Amin (1999) ArticleTitleIntramedullary spinal metastasis from carcinoma of the cervix Br J Radiol 72 89–91
F Jardin A Stamatoullas C Fruchart J D’ Anjou JF Glement H Tilly (1999) ArticleTitleIntramedullary spinal cord metastasis and leptomeningeal involvement in Hodgkin’s disease. Case report and review of the literature Rev Med Interne 20 267–271
Y Li M Takayasu T Takagi M Yooshimoto Y Mitsui J Yoshida (2000) ArticleTitleIntramedullary spinal cord metastasis associated with hemorrhage: a case report No Shinkei Geka 28 453–457
Y Honma K Kawakita S Nagao (1996) ArticleTitleIntramedullary spinal cord and brain metastases from thyroid carcinoma detected 11 years after initial diagnosis-case report Neurol Med Chir (Tokyo) 36 593–597
AW Thomas SR Simon C Evans (1992) ArticleTitleIntramedullary spinal cord metastases from epithelial ovarian carcinoma Gynecol Oncol 44 195–197
FM Salpietro C Alafaci O Gervasio G La Rosa A Baio DC Francolini D Batolo F Tomasello (1998) ArticleTitlePrimary cervical melanoma with brain metastases. Case report and review of the literature J Neurosurg 89 659–666
ES Connolly CJ Winfree PC McCormick M Cruz BM Stein (1996) ArticleTitleIntramedullary spinal cord metastasis: report of three cases and review of the literature Surg Neurol 46 329–338
MJD Post RM Quencer BA Green BM Montalvo JA Tobias JJ Sowers IH Levin (1987) ArticleTitleIntramedullary spinal cord metastases, mainly of nonneurogenic origin AJNR 8 339–346
F Tognetti G Lanzino F Calbucci (1988) ArticleTitleMetastases of the spinal cord from remote neoplasms: study of five cases Surg Neurol 30 220–227
JL Grem J Burgess DL Trump (1985) ArticleTitleClinical features and natural history of intramedullary spinal cord metastasis Cancer 56 2305–2314
RN Edelson MD Deck JB Posner (1972) ArticleTitleIntramedullary spinal cord metastases. Clinical and radiographic findings in nine cases Neurology 22 1222–1231
S Phuphanich S Zachariah B Zachariah NN Ku FR Murtagh (1996) ArticleTitleMagnetic resonance imaging of syrinx associated with intramedullary metastases and leptomeningeal disease J Neuroimaging 6 115–117
DE Weissman SA Grossman (1986) ArticleTitleSimultaneous leptomeningeal and intramedullary spinal metastases in small cell lung carcinoma Med Pediatr Oncol 14 54–56
G Stranjalis MJ Torrens (1993) ArticleTitleSuccessful removal of intramedullary spinal cord metastasis: case report Br J Neurosurg 7 193–195
K Jellinger P Kothbauer E Sunder-Plassmann R Weiss (1979) ArticleTitleIntramedullary spinal cord metastases J Neurol 220 31–41
A Isla JM Paz F Sansivirini P Zamora A Garcia Grande A Fernandez (2000) ArticleTitleIntramedullary spinal cord metastasis: a case report J Neurosurg Sci 44 99–101
A Raco R Delfini M Salvati G Innocenzi P Ciappetta (1992) ArticleTitleIntramedullary metastasis of unknown origin: a case report Neurosurg Rev 15 135–138
JM Findlay M Bernstein RG Vanderlinden L Resch (1987) ArticleTitleMicrosurgical resection of solitary intramedullary spinal cord metastases Neurosurgery 21 911–915
TG Gasser J Pospiech D Stolke K Schwechheimer (2001) ArticleTitleSpinal intramedullary metastases. Report of two cases and review of the literature Neurosurg Rev 24 88–92
R Patchell PA Tibbs WF Regine R Payne S Saris RJ Kryscio B Young (2003) ArticleTitleA randomized trial of direct decompressive surgical resection in the treatment of spinal cord compression caused by metastasis Proc Am Soc Clin Oncol 22 1
JW Dunne CG Harper R Pamphlett (1986) ArticleTitleIntramedullary spinal cord metastases: a clinical and pathological study of nine cases Q J Med 61 1003–1020
MD Winkelman DJ Adelstein NL Karlins (1987) ArticleTitleIntramedullary spinal cord metastasis. Diagnostic and therapeutic considerations Arch Neurol 44 526–531
RR Vindlacheruvu AW McEvoy ND Kitchen (1997) ArticleTitleIntramedullary thoracic cord metastasis managed effectively without surgery Clin Oncol (R Coll Radiol) 9 343–345
RE Decker S Sundrani ML Citron DS Herrschaft (1987) ArticleTitleIntramedullary spinal cord metastases treated by complete resection of tumor prior to radiotherapy and chemotherapy. Case report and review Spine 12 393–395
C Kosmas NA Malamos NB Tsavaris M Stamataki S Stefanou A Gregoriou S Rokana M Vartholomeou MJ Antonopoulos (2002) ArticleTitleLeptomeningeal carcinomatosis after major remission to taxane-based front-line therapy in patients with advanced breast cancer J Neurooncol 56 265–273
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kosmas, C., Koumpou, M., Nikolaou, M. et al. Intramedullary spinal cord metastases in breast cancer: report of four cases and review of the literature. J Neurooncol 71, 67–72 (2005). https://doi.org/10.1007/s11060-004-9177-z
Issue Date:
DOI: https://doi.org/10.1007/s11060-004-9177-z