title: Atypical presentation of a cervical breast-cancer metastasis mimicking a dumbbell-shaped neurinoma.
abstract: BACKGROUND
  Spinal metastases are frequently encountered in patients with breast cancer. Because of recent improvements in oncologic therapies a growing incidence of symptomatic leptomeningeal metastases (LM) should be expected. The differential diagnosis of LM comprises a wide range of conditions, including neurinoma. The radiologic discrimination between metastases and neurinomas is primarily based on distinct neuroimaging features, particularly number, size and growth pattern.
  
  
  METHODS
  We report the first case of a solitary leptomeningeal metastasis of a cervical nerve-root, which mimicked a benign dumbbell-shaped neurinoma, using neuroimaging and visualized intraoperatively. The tumor was successfully treated with surgery followed by adjuvant radiochemotherapy (RCT).
  
  
  CONCLUSIONS
  While the patient history directs towards a metastasis, the localization, growth pattern and MRI signal were concordant with a cervical neurinoma. The current literature is not conclusive concerning the optimal choice of treatment; the therapy is strictly palliative and indications for surgery remain individual decisions. However, due to recent improvements in survival of patients with LM require reconsideration of established strategies.
  
  
  CONCLUSIONS
  The present case report and the reviewed literature point towards a growing clinical relevance of symptomatic LM in cancer patients and their possible atypical presentations and locations.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany. Electronic address: christoph.boese@uk-koeln.de.
authors.forename: Christoph Kolja
authors.initials: CK
authors.lastname: Boese
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043 Marburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Bredow
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.
authors.forename: Nusaiba
authors.initials: N
authors.lastname: Al Muhaisen
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.
authors.forename: Timmo
authors.initials: T
authors.lastname: Koy
keywords: Breast cancer; Leptomeningeal metastasis; Neurinoma; Spinal metastasis