Odontoid process metastasis of bronchial carcinoma as a rare cause for nonmechanical neck pain: a case report

Abstract

Introduction: About 10% of spinal metastases are found in the cervical level. Magnetic resonance imaging is the gold standard for early detection of spinal metastases. The decision whether cervical spine magnetic resonance imaging is requested or not must be made clinically, taking into consideration the patients' detailed pain history.

Case presentation: The case of an 85-year-old patient with a long history of neck pain caused by known multi-level cervical spine degeneration is presented. As conservative treatment became ineffective, he was sent for surgery. Pain character had changed from mechanical to nonmechanical. Therefore, new cervical Magnetic resonance imaging was requested, showing unexpected odontoid process osteolysis. Unknown lung cancer with adrenal and pancreatic metastases was revealed by further investigations.

Conclusion: Detailed pain characterization can already indicate the correct diagnosis. In case of new onset cervical neck pain, magnetic resonance imaging should be performed soon, if pain is characterized as nonmechanical.

Figure 1.

X-ray image of the cervical spine in two planes showing degenerative cervical spine disease with multi-level osteochondrosis. Odontoid process can not be seen.

Figure 2.

T2 weighted image of the cervical spine showing odontoid process osteolysis. Furthermore disc herniation of C4 to C7. No further osteolysis or fractures of the vertebra can be observed.

Figure 3.

Histologic aspect of bronchoscopic biopsies from the right upper pulmonary lobe with medium-sized to large cells displaying moderate to extensive nuclear pleomorphism and extensive mechanical nuclear smearing and an increased number of apoptosis. Immunohistochemistry was negative except for CK7, prompting the diagnosis of large cell undifferentiated carcinoma (H&E).