Intramedullary Spinal Cord Metastases in Breast Cancer: Report a Case

Background: Intramedullary spinal cord metastasis (ISCM) from breast cancer is a relatively rare disease. We present this disease. Case presentation: The patient was a 67-year-old woman with lung metastasis appearing 3 years after breast cancer surgery. Complete remission was achieved for the metastatic lesion with chemotherapy, but multiple cerebellar metastases were found 3 months after the completion of chemotherapy. Whole-brain irradiation was administered, resulting in symptomatic improvement. Approximately 6 months later, the patient experienced weakness in the lower extremities and difficulty walking. Magnetic resonance imaging detected a well-defined intraspinal tumor measuring 13 × 13 × 30 mm at the level of Th12-L1. After 20-Gy irradiation to the tumor, oral steroid administration, and rehabilitation, the patient regained the ability to walk. Eight months have passed, to date, since these interventions and the patient is currently receiving treatment for metastases to bones, including the spine, but is still capable of walking without difficulty. We herein report this case with a review of the relevant literature. Conclusion: ISCM in the breast cancer is relatively rare. But, it is the clinical condition which it should always place in the mind.

The role of intraoperative neurophysiological monitoring in intramedullary spinal cord tumor surgery

Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficult.In recent years,many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of post-operative neurological complications.Modern electrophysiological monitoring technology has advanced considerably,leading to the development of many monitoring methods,such as SSEPs,MEPs,DCM,and EMG,to monitor intramedullary tumors.However,electrophysiological monitoring in tumor resection is still being studied.In this article,we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies.Intratumorally tumors need to be monitored for a summary of the condition of the patient.Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.

Leveraging nano-engineered mesenchymal stem cells for intramedullary spinal cord tumor treatment

Intramedullary spinal cord tumor(IMSCT)is comparatively rare malignant tumor in the central nervous system and is very difficult accessible by conventional chemotherapy regimen.Currently,there are very limited researches for IMSCT treatment using nanomedicine.To fill this gap,we originally reported a targeted strategy by leveraging nano-engineered mesenchymal stem cells(MSCs)for synergistic antiIMSCT treatment.In this study,two mode drugs paclitaxel(PTX)and metformin(MET)were co-loaded in maleimide-modified poly(lactic-co-glycolicacid)(PLGA-MAL)nanoparticles,which were further conjugated onto MSCs surface via the thioether bond formed between PLGA-MAL and MSCs without affecting the migration ability of MSCs.Owing to the excellent tumor tropism and penetrability of MSCs and good biodegradability of PLGA,the designed drug delivery platform could accurately target IMSCT sites to exert long-term synergistic antitumor efficacy,exhibiting promising research value for alternative IMSCT management beyond surgery.

Establishment of intramedullary spinal cord glioma model in rats

Background Treating intramedullary spinal cord gliomas is a big challenge because of limited options, high recurrence rate and poor prognosis. An intramedullary glioma model is prerequisite for testing new treatments. This paper describes the establishment of a rodent intramedullary glioma model and presents functional progression, neuroimaging and histopathological characterization of the tumour model. Methods Fischer344 rats （n=24） were randomized into two groups. Group 1 （n=16） received a 5 pl intramedullary implantation of 9L gliosarcomal （105） cells. Group 2 （n=8） received a 5 pl intramedullary injection of Dulbecco＇s modified Eagle medium. The rats were anesthetized, the spinous process of the T10 vertebra and the ligamentum flavum were removed to expose the T10-11 intervertebral space and an intramedullary injection was conducted into the spinal cord. The rats were evaluated preoperatively and daily postoperatively for neurological deficits using the Basso, Beattie and Bresnahan scale. High resolution magnetic resonance images were acquired preoperatively and weekly postoperatively. When score equal to 0, rats were sacrificed for histopathological examination. Results Rats implanted with 9L gliosarcoma cells had a statistically significant median onset of hind limb paraplegia at （16.0±0.4） days, compared with rats in the control group in which neurological deficits were absent. Imaging and pathological cross sections confirmed intramedullary 9L gliosarcoma invading the spinal cord. Rats in the control group showed no significant functional, radiological or histopathological findings of tumour. Conclusions Rats implanted with 9L cells regularly develop paraplegia in a reliable and reproducible manner. The progression of neurological deficits, neuroimaging and histopathological characteristics of intramedullary spinal cord gliomas in rats is comparable with the behaviour of infiltrative intramedullary spinal cord gliomas in patients.

The MRI manifestations of intramedullary germinoma of the spinal cord:a case report and review of the literature

Primary germinoma in the spinal cord is very rare. Preoperative diagnosis is important because germinomas are sensitive to radiation therapy and chemotherapy so that treatment trends and prognosis differ from other intramedullary spinal cord tumors. Preoperative radiologic diagnosis is very difficult because of this rarity. In this case a 22-year-old woman with a 4-month history of gradual numbness and weakness of both lower extremities was found to have a solid tumor in the thoracic cord between the T9 and T11 vertebral bodies. No other neoplastic lesion was found inside or outside the central nervous system. The patient underwent surgery, and the intrarnedullary lesion was almost totally resected. Serum HCG was elevated postoperatively without pregnancy. The pathological diagnosis was conclusively that of a germinoma. The previous 23 cases of primary spinal cord germinoma were reviewed for comparison.

MAGNETIC RESONANCE IMAGING AND MICROSURGICAL TREATMENT OF INTRAMEDULLARY HEMANGIOBLASTOMA OF THE SPINAL CORD

Thirteen cases of intramedullary hemangioblastoma of the spinal cord were studied radiologically, especially with magnetic resonance imaging (MRI). Microsurgery was used to remove the tumors in all cases. Signs and symptoms were improved in 84.6% of the cases after operation. The diagnosis and microsurgical techniques for excision of intramedullary hemangioblastoma of the spinal cord are discussed. This dis-ease should be differentiated from hydromyelia, intramedullary ependymoma, and vascular malformation of the spinal cord. Total removal of the tumor is recommened.