Cuidados paliativos y medicina

Abstracto

Intramedullary Spinal Cord Metastasis of Bladder Carcinoma: A Case Report

Zümre Arıcan Alıcıkuş, Nesrin Dağdelen, Ä°lknur Bilkay Görken, Tülay Canda and Uğur Mungan

Objective: Intramedullary spinal cord metastasis (ISCM) is a rare type of central nervous system involvement of cancer and there are only two cases of bladder cancer's ISCM in literature. This is the third one presenting with an ISCM of bladder cancer, but is the only one presenting without any additional metastases.

Clinical information: A 76-year-old man had radical radiotherapyand adjuvant chemotherapy for bladder cancer four months ago, and was with no evidence of disease. He suffered from sudden severe pain on his neck and progressive weakness of the extremities. The deep tendon reflexes were hypoactive in upper extremities and absent in lower extremities. There was no other neurological deficit. Magnetic resonance imaging scan revealed an enhancing intramedullary lesion at the level of third cervical vertebra with peritumoural edema. Immediately, his corticotherapy was started and subtotal mass resection with laminectomy was performed. The pathological examination showed a metastatic carcinoma of the bladder cancer. Then, he had fractionated external beam radiotherapy to the cervical region with corticotherapy. After two months with a better neurological state, his clinical state worsened and he died of a cardiopulmonary arrest.

Conclusion: There is no consensus on the best therapy, however, it can be well palliated with combination therapy of surgery, irradiation and corticosteroids.