title: Metastasis of breast cancer to a lumbar spinal nerve root ganglion.
abstract: METHODS
  A case report of a surgically treated metastasis of breast cancer to the L2 nerve root ganglion.
  
  
  OBJECTIVE
  To report of an uncommon site of metastasis as the first manifestation of distant hematogenous spread of breast cancer mimicking a benign lesion.
  
  
  BACKGROUND
  Although metastatic disease is a common condition there are limited reports of metastases to the spinal nerve root ganglion. To our knowledge this is the fourth reported case and the first report of a metastasis of a breast carcinoma.
  
  
  METHODS
  A 46-year-old female patient was admitted with severe right sided radicular pain and moderate weakness of hip flexion and knee extension. Magnetic resonance imaging revealed a small lesion of the L2 nerve root. Intraoperatively an intradural tumor was encountered and debulked. The procedure was followed by radiation therapy.
  
  
  RESULTS
  The operative procedure resulted in complete pain resolution with improved motor function. The histologic examination confirmed the tumor to be a metastasis of breast cancer as determined by immunohistological staining. The patient remained recurrence free at 6 month follow-up.
  
  
  CONCLUSIONS
  Although very rare, metastasis to the spinal nerve root ganglion can be the first manifestation of distant hematogenous metastases of breast cancer. The clinical course is characterized by increasing radicular symptoms-especially intractable pain. The radiologic appearance might mimic a benign lesion. Surgical intervention with tumor debulking followed by radiotherapy provides local tumor control and palliation from pain.
authors.affiliation: Department of Neurosurgery, Waikato Hospital, New Zealand. matthias.schulz@charite.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulz
authors.forename: Duncan
authors.initials: D
authors.lastname: Lamont
authors.forename: Thirayan
authors.initials: T
authors.lastname: Muthu
authors.forename: Zakier
authors.initials: Z
authors.lastname: Hussain
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Balakrishnan
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005727:Ganglia, Spinal / Q000473:pathology*; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010524:Peripheral Nervous System Neoplasms / Q000556:secondary* / Q000601:surgery; D016896:Treatment Outcome