Background. Longitudinally extensive transverse myelitis (LETM) is characterized by spinal cord inflammation extending vertically through three or more vertebral segments. The widespread use of MRI revealed LETM more frequency than ever. We report the case of a patient with pathologically confirmed small-cell lung carcinoma metastasis into the spinal cord presenting as LETM. Case Presentation. A 74-year-old man developed rapidly progressive sensorimotor disturbance and vesicorectal dysfunction. T2-weighted magnetic resonance imaging of the spine revealed LETM at the level of from T3 to conus medullaris; gadolinium enhancement showed concurrent tumor in the thoracic spinal cord from T10 to T11. Systemic survey identified a nodular mass in the lung that was verified as small-cell carcinoma. Following initial failed treatment by high-dose steroid, the patient underwent an emergent microsurgical tumor resection. Histological examination was identical with the lung carcinoma. The patient died of tumor progression at the 47th day after admission. At autopsy, only changes of edema were found in the gray matter of the cord, while tumor cells were not noted in it. Conclusion. Metastasis may rarely present symptoms of LETM. Prompt identification of underlying etiology by contrast examination and systemic survey is crucial for the patient assumed as LETM. 1. Introduction Longitudinally extensive transverse myelitis (LETM) is characterized by spinal cord inflammation extending vertically through three or more vertebral segments [1]. The widespread use of magnetic resonance imaging (MRI) has revealed small cell lung cancer (SCLC) to be associated with many primary pathologies, including inflammatory diseases (collagen disease, neuromyelitis optica, Sj？gren’s syndrome, systemic lupus erythematosus, neuro-Beh？et’s disease, and sarcoidosis); infectious diseases (human T-lymphotropic virus-1-associated myelopathy, human immunodeficiency virus infection, and adverse reaction to influenza vaccination); and noninflammatory diseases (intramedullary spinal neoplasms, spinal cord infarction, and spinal dural arteriovenous fistula) [1–14]. LETM has a heterogeneous pathogenesis, but reported cases associated with malignant disorders were very rare (Table 1). Here, we report a case of LETM due to intramedullary metastasis of small-cell lung carcinoma (SCLC), with rapid progression of paraplegia and sensory disturbance of the lower limbs. This patient presented with LETM on whole-spine MRI; despite intensive treatment, he died 47 days after admission. An autopsy was performed to
References
[1]
C. Trebst, P. Raab, E. V. Voss et al., “Longitudinal extensive transverse myelitis-it's not all neuromyelitis optica,” Nature Reviews Neurology, vol. 7, no. 12, pp. 688–698, 2011.
[2]
W. Akkad, B. Salem, J. W. Freeman, and M. K. Huntington, “Longitudinally extensive transverse myelitis following vaccination with nasal attenuated novel influenza A(H1N1) vaccine,” Archives of Neurology, vol. 67, no. 8, pp. 1018–1020, 2010.
[3]
Y. Ohnaka, M. Nakajima, H. Katoh, H. Ichikawa, and M. Kawamura, “Intramedullary spinal cord metastasis presenting with acute onset longitudinally extensive spinal cord lesion,” Rinsho Shinkeigaku, vol. 50, no. 10, pp. 725–727, 2010.
[4]
H. Nightingale, J. Witherick, and A. Wilkins, “Diagnosis of longitudinally extensive transverse myelitis,” BMJ Case Reports, 2011.
[5]
N. Kumar, B. M. Keegan, F. J. Rodriguez, J. E. Hammack, and O. H. Kantarci, “Intravascular lymphoma presenting as a longitudinally-extensive myelitis: diagnostic challenges and etiologic clues,” Journal of the Neurological Sciences, vol. 303, no. 1-2, pp. 146–149, 2011.
[6]
R. Itami, N. Sanjo, H. Kuwahara et al., “Rapid progressive HTLV-1-associated myelopathy with bronchoalveolar lesions and a long spinal cord lesion extending to almost the entire spinal cord,” Clinical Neurology, vol. 51, no. 2, pp. 130–134, 2011.
[7]
M. Habek, I. Adamec, and V. V. Brinar, “Spinal cord tumor versus transverse myelitis,” Spine Journal, vol. 11, no. 12, pp. 1143–1145, 2011.
[8]
D. Franciotta, E. Zardini, R. Caporali et al., “Systemic sclerosis in aquaporin-4 antibody-positive longitudinally extensive transverse myelitis,” Journal of the Neurological Sciences, vol. 303, no. 1-2, pp. 139–141, 2011.
[9]
J. W. Stanifer, R. George, R. T. Keenan, and E. W. Massey, “What started this? Debilitating longitudinally-extensive myelitis,” The American Journal of Medicine, vol. 125, pp. 1071–1073, 2012.
[10]
C. White, B. Leonard, and A. Patel, “Longitudinally extensive transverse myelitis: a catastrophic presentation of a flare-up of systemic lupus erythematosus,” Canadian Medical Association Journal, vol. 184, no. 3, pp. E197–E200, 2012.
[11]
I. Coulter, S. Huda, A. Baborie, and A. Jacob, “Longitudinally extensive transverse myelitis as the sole presentation of neuro-Beh？et's disease responding to infliximab,” Journal of Spinal Cord Medicine, vol. 35, no. 2, pp. 122–124, 2012.
[12]
R. Salazar, M. Cerghet, A. Shad, and N. P. Markowitz, “NMO-IgG positive relapsing longitudinally extensive transverse myelitis (LETM) in a seropositive HIV patient,” Clinical Neurology and Neurosurgery, vol. 115, pp. 1873–1875, 2013.
[13]
L. K. Huang, C. C. Chung, B. Z. Chen, N. F. Chi, and C. J. Hu, “Systemic lupus erythematosus presented as extensive longitudinal myelitis,” Acta Neurologica Taiwanica, vol. 22, pp. 67–71, 2013.
[14]
D. Graham, A. McCarthy, E. Kavanagh, K. O'Rourke, and T. Lynch, “Teaching NeuroImages: longitudinally extensive transverse myelitis in neuro-Behcet disease,” Neurology, vol. 80, pp. e189–e190, 2013.
[15]
M. Kalayci, F. ？a？avi, S. Gül, S. Yenidünya, B. A？ikg？z, and T. Dóczi, “Intramedullary spinal cord metastases: diagnosis and treatment: an illustrated review,” Acta Neurochirurgica, vol. 146, no. 12, pp. 1347–1354, 2004.
