Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 24, 2016; 5(1): 72-74
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.72
Case of intramedullary spinal cord metastasis of renal cell carcinoma
Hideo Soga, Osamu Imanishi
Hideo Soga, Department of Urology, Sanda City Hospital, Sanda, Hyogo 669-132, Japan
Osamu Imanishi, Department of Urology, Imanishi Urological Clinic, Kobe, Hyogo 657-0846, Japan
Author contributions: All authors contributed equally to this work.
Institutional review board statement: None.
Informed consent statement: None.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hideo Soga, MD, PhD, Department of Urology, Sanda City Hospital, 3-1-1, Keyaki-dai, Sanda, Hyogo 669-132, Japan. uro-hideo@pop11.odn.ne.jp
Telephone: +81-79-5658000 Fax: +81-79-5658017
Received: June 6, 2015
Peer-review started: June 10, 2015
First decision: August 18, 2015
Revised: November 13, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: March 24, 2016
Abstract

Intramedullary spinal cord tumors are rare. The improved survival resulting from more effective treatments for many cancers has led to an increased number of publications concerning intramedullary spinal cord metastasis (ISCM), including case reports and literature reviews; however, ISCM remains extremely rare in renal cancer. A 69-year-old man with a medical history of renal cell carcinoma (RCC) presented with urinary retention and bilateral paralysis of the lower extremities. A neurological examination revealed bilateral paraparesis below L1. Although brain magnetic resonance imaging (MRI), bone scintigraphy, and abdominal contrast-enhanced computed tomography revealed no abdominal findings, the thracolumbar MRI indicated a spot on the spinal cord at the Th12 level that exhibited hyperintensity on T2-weighted imaging and gadolinium diethylenetriaminepentaacetic acid enhancement on T1-weighted imaging. Accordingly, an ISCM of RCC was diagnosed. The patient rejected all treatments for these metastases except the steroid therapy. The patient’s condition deteriorated owing to metastatic progression, and he died 3 mo after the appearance of ISCM symptoms. The prognosis of this condition was poor. The mean survival durations were 8 mo with surgical treatment, 4 mo with irradiation, and 2 mo with palliative treatments. In cases involving neurological features and if brain or bone metastasis or spinal cord compression is not clearly observed, gadolinium-enhanced MRI should be performed to determine the existence of ISCM. Recently, some authors have reported the efficacy of ISCM resection. Surgical treatment could potentially yield improvements in the nervous symptoms or a longer survival after treatment. Although the prognosis was poor in most cases of ISCM, surgical treatment may improve the patient’s quality of life.

Keywords: Renal cancer, Intramedullary spinal cord metastasis, Magnetic resonance imaging

Core tip: Intramedullary spinal cord metastasis (ISCM) is extremely rare in renal cancer. A 69-year-old man with a medical history of renal cell carcinoma presented with urinary retention and bilateral paralysis of the lower extremities. A neurological examination revealed bilateral paraparesis below L1. ISCM of renal cell carcinoma was diagnosed via thracolumbar gadolinium-enhanced magnetic resonance imaging (MRI). In a case involving neurological features and if brain or bone metastasis or spinal cord compression is not clearly observed, gadolinium-enhanced MRI should be performed to reveal the existence of ISCM.