Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Abstract

We report and analyze a rare entity of intramedullary spinal cord tumor, which is metastatic from colon cancer with a very poor prognosis. The reported 19 cases including our case in the literature are analyzed. Comparison of outcomes between surgery, radiotherapy and non-treatment groups are evaluated. Life distribution is profiled. Median overall survival is 75 days. The 90 days and 150 days survival rate are 42.9% and 21.4%, respectively. There were no differences between conservative treatment (non-treatment or radiotherapy) and aggressive intervention (surgery or surgery plus radiotherapy) in mortality and the trend of survival probability. The prognosis of metastatic intramedullary spinal cord tumor is poor. Surgery may only be considered in selected patients with good control of primary cancer and without evidence of lung metastases and leptomeningeal carcinomatosis.

Keywords: Cancer; Outcomes research.

Figure 1

(a) Sagittal view of magnetic resonance imaging with enhancement showed an intramedullary spinal cord tumor at T9 level (arrow). (b) Section from the colon specimen showed adenocarcinoma composed of hyperchromatic and pleomorphic cancer cells arranged in glandular pattern with surrounding desmoplastic stroma. (c) Section from spinal cord lesion with immunohistochemistry stains showed neoplastic cells positive for cytokeratin 20 (CK20) but negative for cytokeratin 7 (CK7), caudal-related homeobox transcription factor 2 (CDX-2) and thyroid transcription factor-1 (TTF-1). The results were highly suggestive of metastatic adenocarcinoma.

Figure 2

(a) There is no difference of survival rate between conservative treatment (non-treatment or radiotherapy) and aggressive intervention (surgery or surgery plus radiotherapy). (b) The overall trend of survival probability in 14 cases.