Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma

Joong-Won Ha; Yung Park; Sung-Guk Kim; Yoon-Jeong Choi; Seung-Ho Joo

doi:10.4184/jkss.2009.16.2.138

Journal List > J Korean Soc Spine Surg > v.16(2) > 1035845

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Ha, Park, Kim, Choi, and Joo: Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma

A Case Report

Journal of Korean Spine Surg 2009;16(2):138-141.

Published online: 21 February 2009

DOI: https://doi.org/10.4184/jkss.2009.16.2.138

Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma

Joong-Won Ha, M.D., Yung Park, M.D., Sung-Guk Kim, M.D., Yoon-Jeong Choi, M.D.^#, Seung-Ho Joo, M.D.^$

Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital, Ilsan, Korea

^#Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Ilsan, Korea

^$Departement of Radiology, National Health Insurance Corporation Ilsan Hospital, Ilsan, Korea

Address reprint requests to Yung Park, M.D. Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital 1232, Baeksuk-dong, Ilsandong-gu, Goyang, Gyeonggi, Korea, Tel: 82-31-900-0540, Fax: 82-31-900-0343, E-mail: jiupark@yahoo.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

An intradural extramedullary metastasis to the spinal nerve root across dura mater is extremely rare. The authors encountered a case 39-year-old man who suffered radiculopathy arising from a soft mass around nerve root mimicking a nerve sheath tumor compressing the 4th lumbar nerve root in the right intervertebral foramen between the 4th and 5th lumbar spine. After an excisional biopsy, the metastatic infiltration of adenocarcinoma was confirmed pathologically. The primary lesion was found to be an intrahepatic cholangiocarcinoma with multiple metastases. This report suggests that an intradural metastatic tumor can show similar clinical and radiographic findings to other disease,s such as a nerve sheath tumor. The results also suggest that proper diagnosis and further treatment are possible only by pathological confirmation after and excisional biopsy.

Keywords: Spinal nerve, Intradural extramedullary metastasis, Cholangiocarcinoma

REFERENCES

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Fig. 1.

Findings of Magnetic Resonance Imaging. A. Axial T2-weighted image (TR 3500/TE107) is showing a right-sided fusiform shaped spinal nerve root mass (arrow) with intermediate signal intensity compressing spinal nerve. B. Sagittal T1-weighted image (TR 300/TE 10) is showing isointense mass (arrow) enlarging intervertebral neural foramen. C-D. Contrast-enhanced T1-weighted fat suppression axial (TR 467/TE 10) and sagittal (TR 350/TE 9) images are showing highly enhancing mass (arrow) with internal cystic or necrotic portion.

Fig. 2.

Diffuse infiltration of well-differentiated adenocarcinoma(white arrow) in nerve tissues & ganglions(black arrow) was noted.(H&E, ×200)

Fig. 3.

Contrast-enhanced CT scan is showing a hypoattenuating irregular large cholangiocarcinoma (arrow) with peripheral rim enhancement (arrowheads) in left lobe of liver.

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