Intradural Spinal Metastasis from Renal Cell Carcinoma: A Rare Entity

Abstract

Renal cell carcinoma constitutes about 2% of all malignant neoplasms. It is known to metastasize to lung, bone and lymph nodes; intradural spinal metastases (IDSM) are relatively uncommon, only 5% as per literature. Keeping in mind the curative, functional, and palliative aspects; the management should be tailored for each patient. Surgery represents the gold standard of treatment for spinal metastases. However Radiation therapy offers a less invasive means of tumor control, and can be utilized as the initial treatment or as an adjunct in the postoperative setting. The decision to use radiation therapy largely depends on factors, namely neurologic compromise, overall performance, and systemic tumor burden. Here we present a case of 66 year old male, diagnosed as renal cell carcinoma - clear cell histology. Patient was subjected to radical nephrectomy & subsequently put on ‘pazopanib. While on pazopanib patient developed low back pain, evaluation revealed spinal cord lesion adjacent to L2&3 lumbar vertebrae suggestive of intradural metastasis. Patient was treated with external beam radiotherapy (EBRT) after he refused surgery & subsequent evaluation revealed complete disappearance of spinal lesion. Patient is alive & still on follow up.