Skip to main content
Log in

Intradural extramedullary spinal metastasis of renal cell carcinoma: illustrative case report and comprehensive review of the literature

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Study design

Literature review.

Objectives

Intradural metastasis of renal cell carcinoma (RCC) has rarely been reported. We describe a case of an intradural extramedullary spinal metastasis to the cervical spine in a 68-year-old male treated for RCC 22 years prior. Additionally, we review the known reports of both intradural extramedullary and intramedullary of RCC.

Methods

Case report and literature review.

Results

A 68-year-old male with a history of right-sided nephrectomy for RCC preformed 22 years prior now presents with a MRI of the cervical spine showing a 1.5 cm contrast enhancing intradural extramedullary lesion at the level of C3–C4. Surgical resection of the lesion was performed. The tumor’s histological and immunohistochemical profile was consistent with metastatic RCC. There are 18 reported cases of intradural extramedullary metastases of sporadic RCC. The average age at diagnosis was 61.6 ± 14.3 years. The interval from diagnosis of primary RCC to diagnosis metastasis ranged from 0 to 264 months (mean 46.8 ± 74.0 months). Sixteen cases of intramedullary renal cell carcinoma metastasis are reported. The average age at time of diagnosis was 53.6 ± 10.2 years. The interval from diagnosis of primary RCC to diagnosis of metastasis ranged from 0 to 180 months (mean 20.9 ± 53.4 months).

Conclusion

The 22-year interval from diagnosis of primary RCC to intradural metastasis is the longest latency reported in the literature. Intramedullary metastases tend to have a younger age at diagnosis and shorter interval from diagnosis of primary RCC compared to extramedullary lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lam JS, Leppert JT, Belldegrun AS, Figlin RA (2005) Novel approaches in the therapy of metastatic renal cell carcinoma. World J Urol 23(3):202–212. https://doi.org/10.1007/s00345-004-0466-0

    Article  CAS  PubMed  Google Scholar 

  2. Motzer RJ, Bander NH, Nanus DM (1996) Renal-cell carcinoma. N Engl J Med 335(12):865–875. https://doi.org/10.1056/NEJM199609193351207

    Article  CAS  PubMed  Google Scholar 

  3. Ritchie AW, deKernion JB (1987) The natural history and clinical features of renal carcinoma. Semin Nephrol 7(2):131–139

    CAS  PubMed  Google Scholar 

  4. Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, Tian Z, Schmitges J, Graefen M, Perrotte P, Menon M, Montorsi F, Karakiewicz PI (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23(4):973–980. https://doi.org/10.1093/annonc/mdr362

    Article  CAS  PubMed  Google Scholar 

  5. Capek S, Krauss WE, Amrami KK, Parisi JE, Spinner RJ (2016) Perineural spread of renal cell carcinoma: a case illustration with a proposed anatomic mechanism and a review of the literature. World Neurosurg 89(728):e711–727. https://doi.org/10.1016/j.wneu.2016.01.060

    Article  Google Scholar 

  6. Ji GY, Oh CH, Kim SH, Shin DA, Kim KN (2013) Intradural cauda equina metastasis of renal cell carcinoma: a case report with literature review of 10 cases. Spine (Phila Pa 1976) 38(18):E1171–E1174. https://doi.org/10.1097/BRS.0b013e31829cef66

    Article  Google Scholar 

  7. Jost G, Zimmerer S, Frank S, Cordier D, Merlo A (2009) Intradural spinal metastasis of renal cell cancer. Report of a case and review of 26 published cases. Acta Neurochir (Wien) 151(7):815–821. https://doi.org/10.1007/s00701-009-0358-6(discussion 821)

    Article  Google Scholar 

  8. Strong C, Yanamadala V, Khanna A, Walcott BP, Nahed BV, Borges LF, Coumans JV (2013) Surgical treatment options and management strategies of metastatic renal cell carcinoma to the lumbar spinal nerve roots. J Clin Neurosci 20(11):1546–1549. https://doi.org/10.1016/j.jocn.2013.02.014

    Article  PubMed  PubMed Central  Google Scholar 

  9. Srinivasan A, Dhandapani S, Chatterjee D, Simha V (2014) Renal small cell carcinoma presenting with solitary lumbar intradural metastasis. Neurol India 62(5):561–563. https://doi.org/10.4103/0028-3886.144494

    Article  PubMed  Google Scholar 

  10. Kim DY, Lee JK, Moon SJ, Kim SC, Kim CS (2009) Intradural spinal metastasis to the cauda equina in renal cell carcinoma: a case report and review of the literature. Spine (Phila Pa 1976) 34(24):E892–E895. https://doi.org/10.1097/BRS.0b013e3181b34e6c

    Article  Google Scholar 

  11. Kubota M, Saeki N, Yamaura A, Iuchi T, Ohga M, Osato K (2004) A rare case of metastatic renal cell carcinoma resembling a nerve sheath tumor of the cauda equina. J Clin Neurosci 11(5):530–532. https://doi.org/10.1016/j.jocn.2003.09.010

    Article  PubMed  Google Scholar 

  12. Heary RF, Agarwal N, Barrese JC, Barry MT, Baisre A (2014) Metastatic renal cell carcinoma, with a radiographically occult primary tumor, presenting in the operative site of a thoracic meningioma: long-term follow-up: Case report. J Neurosurg Spine 21(4):628–633. https://doi.org/10.3171/2014.6.SPINE13448

    Article  PubMed  Google Scholar 

  13. Maxwell M, Borges LF, Zervas NT (1999) Renal cell carcinoma: a rare source of cauda equina metastasis. Case Rep J Neurosurg 90(1 Suppl):129–132

    CAS  Google Scholar 

  14. Mak KH, Kwok JC (2001) Intradural spinal metastasis from renal cell carcinoma: a case report. J Orthop Surg (Hong Kong) 9(2):57–61. https://doi.org/10.1177/230949900100900212

    Article  Google Scholar 

  15. Gaetani P, Di Ieva A, Colombo P, Tancioni F, Aimar E, Debernardi A, Rodriguez YBR (2004) Intradural spinal metastasis of renal clear cell carcinoma causing cauda equina syndrome. Acta Neurochir (Wien) 146(8):857–861. https://doi.org/10.1007/s00701-004-0299-z

    Article  CAS  Google Scholar 

  16. Dobson GM, Polvikoski T, Nissen JJ, Holliman D (2013) Cauda equina syndrome secondary to intradural renal cell carcinoma metastasis haemorrhage. Br J Neurosurg 27(2):249–250. https://doi.org/10.3109/02688697.2012.724122

    Article  PubMed  Google Scholar 

  17. Takada T, Doita M, Nishida K, Miura J, Yoshiya S, Kurosaka M (2003) Unusual metastasis to the cauda equina from renal cell carcinoma. Spine (Phila Pa 1976) 28(6):E114–E117. https://doi.org/10.1097/01.BRS.0000049910.72881.A0

    Article  Google Scholar 

  18. Lin TK, Chen SM, Jung SM (2011) Solitary intradural extramedullary metastasis of renal cell carcinoma to the conus medullaris. Kaohsiung J Med Sci 27(1):45–48. https://doi.org/10.1016/j.kjms.2010.05.001

    Article  PubMed  Google Scholar 

  19. Takahashi I, Isu T, Iwasaki Y, Akino M, Takahashi A, Abe H, Kitagawa M, Kojima H, Inoue K, Saitoh H (1990) Metastatic Grawitz's tumor to the cauda equina: case report. No Shinkei Geka 18(12):1157–1160

    CAS  PubMed  Google Scholar 

  20. Zakaria Z, Fenton E, Jansen M, O'Brien D (2012) The occult nature of intramedullary spinal cord metastases from renal cell carcinoma. BMJ Case Rep. https://doi.org/10.1136/bcr-2012-007476

    Article  PubMed  PubMed Central  Google Scholar 

  21. Poggi MM, Patronas N, Buttman JA, Hewitt SM, Fuller B (2001) Intramedullary spinal cord metastasis from renal cell carcinoma: detection by positron emission tomography. Clin Nucl Med 26(10):837–839

    Article  CAS  Google Scholar 

  22. Asadi M, Rokni-Yazdi H, Salehinia F, Allameh FS (2009) Metastatic renal cell carcinoma initially presented with an intramedullary spinal cord lesion: a case report. Cases J 2:7805. https://doi.org/10.4076/1757-1626-2-7805

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kaya RA, Dalkilic T, Ozer F, Aydin Y (2003) Intramedullary spinal cord metastasis: a rare and devastating complication of cancer–two case reports. Neurol Med Chir (Tokyo) 43(12):612–615

    Article  Google Scholar 

  24. Parikh S, Heron DE (2009) Fractionated radiosurgical management of intramedullary spinal cord metastasis: A case report and review of the literature. Clin Neurol Neurosurg 111(10):858–861. https://doi.org/10.1016/j.clineuro.2009.06.008

    Article  PubMed  Google Scholar 

  25. Gao J, Li Y, Yang Z, Wang R (2014) Intramedullary spinal cord metastasis of renal cell carcinoma 6 years following the nephrectomy. Turk Neurosurg 24(2):294–296. https://doi.org/10.5137/1019-5149.JTN.7805-13.0

    Article  PubMed  Google Scholar 

  26. Park J, Chung SW, Kim KT, Cho DC, Hwang JH, Sung JK, Lee D (2013) Intramedullary spinal cord metastasis in renal cell carcinoma: a case report of the surgical experience. J Korean Med Sci 28(8):1253–1256. https://doi.org/10.3346/jkms.2013.28.8.1253

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schijns OE, Kurt E, Wessels P, Luijckx GJ, Beuls EA (2000) Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 102(4):249–254

    Article  CAS  Google Scholar 

  28. Fakih M, Schiff D, Erlich R, Logan TF (2001) Intramedullary spinal cord metastasis (ISCM) in renal cell carcinoma: a series of six cases. Ann Oncol 12(8):1173–1177

    Article  CAS  Google Scholar 

  29. Ateaque A, Martin JL, O'Brien C (2000) Intramedullary spinal cord metastases from a hypernephroma 11 years following the diagnosis and treatment of the primary lesion. Br J Neurosurg 14(5):474–476

    Article  CAS  Google Scholar 

  30. Donovan DJ, Freeman JH (2006) Solitary intramedullary spinal cord tumor presenting as the initial manifestation of metastatic renal cell carcinoma: case report. Spine (Phila Pa 1976) 31(14):E460–463. https://doi.org/10.1097/01.brs.0000222022.67502.4e

    Article  Google Scholar 

  31. Gomez de la Riva A, Isla A, Perez-Lopez C, Budke M, Gutierrez M, Frutos R (2005) Intramedullary spinal cord metastasis as the first manifestation of a renal carcinoma. Neurocirugia (Astur) 16(4):359–364

    Article  CAS  Google Scholar 

  32. Pagano S, Ruggeri P, Franzoso F, Brusamolino R (1995) Unusual renal cell carcinoma metastasis to the gallbladder. Urology 45(5):867–869. https://doi.org/10.1016/S0090-4295(99)80097-1

    Article  CAS  PubMed  Google Scholar 

  33. Weiss L, Harlos JP, Torhorst J, Gunthard B, Hartveit F, Svendsen E, Huang WL, Grundmann E, Eder M, Zwicknagl M et al (1988) Metastatic patterns of renal carcinoma: an analysis of 687 necropsies. J Cancer Res Clin Oncol 114(6):605–612

    Article  CAS  Google Scholar 

  34. Saitoh H, Shimbo T, Tasaka T, Iida T, Hara K (1982) Brain metastasis of renal adenocarcinoma. Tokai J Exp Clin Med 7(3):337–343

    CAS  PubMed  Google Scholar 

  35. Perrin RG, Livingston KE, Aarabi B (1982) Intradural extramedullary spinal metastasis. A report of 10 cases. J Neurosurg 56(6):835–837. https://doi.org/10.3171/jns.1982.56.6.0835

    Article  CAS  PubMed  Google Scholar 

  36. Brotchi J (2002) Intrinsic spinal cord tumor resection. Neurosurgery 50(5):1059–1063

    PubMed  Google Scholar 

  37. Kalayci M, Cagavi F, Gul S, Yenidunya S, Acikgoz B (2004) Intramedullary spinal cord metastases: diagnosis and treatment—an illustrated review. Acta Neurochir (Wien) 146(12):1347–1354. https://doi.org/10.1007/s00701-004-0386-1(discussion 1354)

    Article  CAS  Google Scholar 

  38. Maor MH, Frias AE, Oswald MJ (1988) Palliative radiotherapy for brain metastases in renal carcinoma. Cancer 62(9):1912–1917

    Article  CAS  Google Scholar 

  39. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924. https://doi.org/10.1016/j.eururo.2015.01.005

    Article  PubMed  Google Scholar 

  40. De Meerleer G, Khoo V, Escudier B, Joniau S, Bossi A, Ost P, Briganti A, Fonteyne V, Van Vulpen M, Lumen N, Spahn M, Mareel M (2014) Radiotherapy for renal-cell carcinoma. Lancet Oncol 15(4):e170–177. https://doi.org/10.1016/S1470-2045(13)70569-2

    Article  PubMed  Google Scholar 

  41. Tunio MA, Hashmi A, Rafi M (2010) Need for a new trial to evaluate postoperative radiotherapy in renal cell carcinoma: a meta-analysis of randomized controlled trials. Ann Oncol 21(9):1839–1845. https://doi.org/10.1093/annonc/mdq028

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Simon Hanft.

Ethics declarations

Conflict of interest

None of the authors have any potential conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carminucci, A., Hanft, S. Intradural extramedullary spinal metastasis of renal cell carcinoma: illustrative case report and comprehensive review of the literature. Eur Spine J 29 (Suppl 2), 176–182 (2020). https://doi.org/10.1007/s00586-020-06537-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-020-06537-x

Keywords

Navigation