Multiple Spinal Intradural-Intramedullary Involvement by Metastatic Carcinoma with Neuroendocrine Differentiation with Occult Primary—An Unusual Case Report and Review of Literature

Although vertebral column is recognized as the most common site for bony metastasis in patient with systemic malignancy, intramedullary metastases to the spinal cord is infrequent. Between 5% - 10% of cancer patients develop spinal metastasis during the course of their diseases. Intramedullary tumors are rare, comprising 3.5% of spinal metastasis. Most metastatic spinal lesions (70%) are found at the thoracic level, 20% in lumbar region and 10% in the cervical region. We report a rare biopsy proven case of intramedullary spinal metastatic carcinoma with neuroendocrine differentiation because of its unusual presentation, involving spine at multiple noncontiguous levels, which appeared as irregular small nodules on MRI. The primary tumor was most likely from occult primary in lung. Biopsy from the spinal lesion established the diagnosis of metastatic carcinoma with neuroendocrine differentiation. Therefore, in patients with spinal metastasis, a thorough work up is advised to evaluate primary site. This would help to delineate the nature and the extent of the systemic disease. We highlighted herein the clinical presentation, radiological findings particularly MRI and role of biopsy in the diagnosis and treatment of intramedullary spinal metastasis.