腎細胞がんの脊髄硬膜内髄外転移と髄内浸潤をきたした1例

抄録

  Intradural extramedullary metastases of renal cell carcinoma are rare. We report a case of intradural extramedullary spinal cord metastasis and intramedullary invasion of renal cell carcinoma after treatment for brain and lung metastases following initial removal.

  A 43-year-old woman presented with a history of right renal cell carcinoma. She developed sudden disturbances in consciousness and dizziness and was transferred to our hospital at the age of 40 years. The cerebellar metastasis presented with cerebellar hemorrhage. We removed the left cerebellar hemorrhage, which led to the diagnosis of brain metastasis from renal cell carcinoma. The patient underwent cranial radiotherapy and chemotherapy. Three years later, thoracic magnetic resonance imaging (MRI) revealed T2 dorsal and T2-3 ventral intradural extramedullary tumors. The tumor had grown within 6 months, and the patient complained of chest and back pain. She also had bilateral lower-limb paralysis, bilateral lower-limb sensory deficits, and bladder and bowel dysfunctions. Tumor embolization and partial removal of thoracic spinal cord tumors were performed. Intraoperative findings revealed an indistinct boundary between the ventral spinal tumor and spinal cord. We diagnosed the patient with intradural extramedullary metastasis of renal cell carcinoma and medullary invasion of the extramedullary tumor. The patient underwent postoperative spinal radiotherapy and chemotherapy. Neurological symptoms improved postoperatively and were maintained for 18 months postoperatively.

  Despite the poor prognosis of renal cell carcinoma and its metastasis to the spinal cord, palliative surgery and adjuvant therapy may maintain the quality of life and activities of daily living in patients.