title: Large cell neuroendocrine carcinoma of the lung metastatic to the cauda equina.
abstract: BACKGROUND
  Large cell neuroendocrine carcinoma of the lung is an aggressive tumor with unique histopathological features. It is not known to metastasize to the spine.
  
  
  OBJECTIVE
  To report a metastatic case of this rare tumor to the cauda equina.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Retrospective case review and review of the literature.
  
  
  RESULTS
  The authors report a rare case of a large cell neuroendocrine lung metastasis to the lumbar spine, causing right foot drop. Magnetic resonance imaging revealed a heterogeneously enhancing intradural extramedullary mass at L2/L3 level compressing the surrounding nerve roots. During surgery, the identified nerve roots were encased by the tumor, and the dissection was tedious. Postoperatively, the patient reported significantly improved back pain and he had severe foot weakness. The functional outcome was poor because the patient lost entirely his foot function; however, his back pain improved significantly after surgery.
  
  
  CONCLUSIONS
  This is the first published study in which the authors described a metastasis of a rather uncommon lung cancer to the cauda equina. When a lesion of the cauda equina presents with a rapid progressive neurological deficit, leptomeningeal metastasis should be in the differential diagnosis.
authors.affiliation: Department of Neurological Surgery, University of Miami, Miller School of Medicine, Lois Pope Life Center, Miami, FL 33136, USA. atsimpas@med.miami.edu
authors.forename: Asterios
authors.initials: A
authors.lastname: Tsimpas
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Post
authors.forename: Yaron
authors.initials: Y
authors.lastname: Moshel
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Frempong-Boadu
mesh_terms: D018287:Carcinoma, Large Cell / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D002420:Cauda Equina / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010524:Peripheral Nervous System Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012907:Smoking / Q000009:adverse effects