title: Metastatic renal cell carcinoma initially presented with an intramedullary spinal cord lesion: a case report.
abstract: BACKGROUND
  One of the rare manifestations of systemic neoplasia is intramedullary spinal cord metastasis that causes serious diagnostic and therapeutic dilemma. It has been very rarely reported as the initial manifestation of carcinoma. This is report of a metastatic renal cell carcinoma initially presented with intramedullary spinal cord lesion, to our knowledge there are few similar reports in literature.
  
  
  METHODS
  We report a 51-year-old Iranian woman who presented with back pain and paraparesis. MR imaging study of her spine showed an enhancing cystic lesion at the level of conus medullaris. Despite detailed investigation, no specific aetiology was found till a bone scan obtained to evaluate an agonizing pain on the dorsum of the left hand revealed photon deficient area within the left kidney in addition to oseoblastic bony lesions. After thorough imaging investigation she underwent radical nephrectomy which confirmed renal cell carcinoma.
  
  
  CONCLUSIONS
  Considering the prevalence of cancer, it is imperative that clinicians be mindful of occult carcinoma as the cause of suspicious intramedullary spinal cord lesion.
authors.affiliation: Department of General Internal Medicine, Imam Khomeini Hospital, Keshavarz Boulevard, Medical Sciences/Tehran University,Tehran, Iran. mehrnazasadi@yahoo.com
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Asadi
authors.forename: Hadi
authors.initials: H
authors.lastname: Rokni-Yazdi
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Salehinia
authors.forename: Farshad S
authors.initials: FS
authors.lastname: Allameh