Renal cell carcinoma and intradural spinal metastasis with cauda equina infiltration: case report--part II.
METHODS
A case report and clinical discussion.


OBJECTIVE
To describe the diagnosis, pathophysiology, and treatment of a papillary renal cell carcinoma that developed an intradural spinal mass with cauda equina infiltration.


BACKGROUND
Cancers that metastasize intradurally to the spinal canal are uncommon, accounting for the 6% of all spinal metastases. Those from renal cell carcinoma are especially unusual. Only 3 reports that describe the spread of metastatic renal cell carcinoma to the cauda equina have been published to our knowledge.


METHODS
A female patient had undergone nephrectomy for the treatment of the papillary renal cell carcinoma 2 years before, and only 1 localization (at the genital tract) was previously diagnosed. The patient presented with lower back pain irradiated to both legs, vesical incontinence, and severe paraparesis.


RESULTS
Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass from L3-L5 with infiltration of the cauda equina; the lesion measured 62 mm craniocaudally and 16 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed.


CONCLUSIONS
The majority of cauda equina tumors are primary tumors, and metastases are very rare. To our knowledge, this is the fourth case described of metastasis of renal cell carcinoma at the cauda equina and the first of papillary type.
Alfieri
Alex
A
Neurosurgical Department, Bolzano General Hospital, Bolzano/Bozen, Italy. alex.alfieri@asbz.it
Mazzoleni
Guido
G
Schwarz
Andreas
A
Campello
Mauro
M
Broger
Maximilian
M
Vitale
Mario
M
Vigl
Edoardo Egarter
EE
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000556:secondary* / Q000601:surgery; D002420:Cauda Equina / Q000473:pathology*; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D017116:Low Back Pain / Q000209:etiology; D008279:Magnetic Resonance Imaging; D009392:Nephrectomy; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000556:secondary*