Metastasis, spinal

4% of intramedullary tumors are metastases, according to operative reports provided by neurosurgical departments. Indeed, it is difficult to ascertain the true incidence of spinal cord metastases as the clinical picture often is atypical and seen in terminally ill patients.

Autopsy material is also biased as the cord is often not systematically examined.

On the other hand, 2.4% of metastases removed surgically from the CNS are located in the cord.

Clinical symptoms are almost always nonspecific, but usually involve root pain.

The exquisite sensitivity of MRI enables intramedullary metastases to be easily detected. No specific MRI characteristics are seen. Usually they are small, nodular, well-defined lesions, hypointense on T2WI. The enhancement pattern may be either ring-like or homogeneous and intense (image 1).

Histology

The glandular differentiation of these epithelial neoplastic cells (image 3) is confirmed by special mucin staining. The epithelial origin of these neoplastic cells is confirmed by immunochemistry (Keratin) (image 2).

Cases

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- Metastasis
- Intramedullary metastasis

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