Lumbar Epidural Metastasis of Breast Cancer Resembling Lumbar Disc Herniation

A 49-year-old woman who had breast cancer suffered from left leg pain. Initial MRI indicated lumbar disc herniation compressing S1 nerve root. The pain was uncontrollable with conservative treatments and she underwent surgical decompression. Intraoperative findings showed that left S1 nerve root was compressed by soft and gray tumor locating ventrally. We resected the tumor and S1 nerve root was adequately decompressed. Bone tissue around the tumor was intact, and there was no finding of bone metastasis. Pathological examination demonstrated adenocarcinoma as same as original breast cancer. We should constantly consider differential diagnosis as metastatic lesion in case of malignancy.

Solitary Spinal Epidural Metastasis from Gastric Cancer

Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

Solitary Spinal Epidural Metastasis from Prostatic Small Cell Carcinoma

Solitary, spinal epidural metastasis (SEM) that is not related to vertebral metastasis is very rare. And solitary SEM from prostatic cancer is rarely found in previously published reports. However, it is clinically significant due to the possibility of neurologic dysfunction, and it can be assessed by MRI. In this report, we show a case of solitary SEM arising from prostatic small cell carcinoma detected by MRI.

Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population

ABSTRACT Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient’s survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient’s survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that differences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.