Alessandra Di Sibio1, Lucia Romano2, Antonio Giuliani3, Marco Varrassi1, Maria Carmela De Donato4, Antonio Iacopino4, Marco Perri1, Mario Schietroma3, Francesco Carlei3, Ernesto Di Cesare4, Carlo Masciocchi4. 1. Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy. 2. Department of Surgery, University of L'Aquila, L'Aquila, Italy; Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy. Electronic address: lucia.romano1989@libero.it. 3. Department of Surgery, University of L'Aquila, L'Aquila, Italy; Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy. 4. Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
Abstract
INTRODUCTION: Nerve root metastasis without extension from an adjacent process has been seldom reported in case of solid tumors. We describe a case of solitary nerve root metastasis of gastric adenocarcinoma, likely due to hematogenous spread. CASE PRESENTATION: A 75-year-old man presented with radiculopathy refractory to medical treatment. MRI and CT demonstrated a right-sided S1 nerve root mass involving the spinal ganglion in its intra-foraminal region with avid enhancement, initial erosive bone changes on sacral foramina and focal hyperaccumulation on 18F - FDG CT-PET, suspicious for metastasis. The histopathological examination confirmed a metastasis of gastric adenocarcinoma. DISCUSSION: A review of the current literature revealed only ten cases of hematogenous metastases to spinal nerve root ganglia; the primary lesions in those cases were an oat cell carcinoma of the lung, two cases of colonic adenocarcinoma, a case of uterine adenocarcinoma, a ductal breast carcinoma, a Ewing's sarcoma, a Renal Cell Carcinoma, a gastro-intestinal stromal tumor, a follicular thyroid carcinoma, a pulmonary adenocarcinoma. CONCLUSION: In the setting of a known malignancy, a nerve root metastasis should be considered in the differential diagnosis of a nerve root mass, although it occurs very rarely.
INTRODUCTION: Nerve root metastasis without extension from an adjacent process has been seldom reported in case of solid tumors. We describe a case of solitary nerve root metastasis of gastric adenocarcinoma, likely due to hematogenous spread. CASE PRESENTATION: A 75-year-old man presented with radiculopathy refractory to medical treatment. MRI and CT demonstrated a right-sided S1 nerve root mass involving the spinal ganglion in its intra-foraminal region with avid enhancement, initial erosive bone changes on sacral foramina and focal hyperaccumulation on 18F - FDG CT-PET, suspicious for metastasis. The histopathological examination confirmed a metastasis of gastric adenocarcinoma. DISCUSSION: A review of the current literature revealed only ten cases of hematogenous metastases to spinal nerve root ganglia; the primary lesions in those cases were an oat cell carcinoma of the lung, two cases of colonic adenocarcinoma, a case of uterine adenocarcinoma, a ductal breast carcinoma, a Ewing's sarcoma, a Renal Cell Carcinoma, a gastro-intestinal stromal tumor, a follicular thyroid carcinoma, a pulmonary adenocarcinoma. CONCLUSION: In the setting of a known malignancy, a nerve root metastasis should be considered in the differential diagnosis of a nerve root mass, although it occurs very rarely.