multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency because of advancement of chemotherapy technology and resultant longer patient survival times .
the incidence of multiple primary malignancies is approximately 0.73% to 11.7% of cancer patients6 ) and incidence of the metachronous second primary cancers was 3.8%.14 ) intramedullary spinal cord metastasis ( iscm ) is found in only 1.65% of autopsy studies of patients with lung cancer.11 ) iscm raises many ethical concerns and challenges in treatment because determination of the most appropriate treatment must be made based on medical conditions and expected survival of the patient .
the author experienced a case of metastasis of metachronous basaloid carcinoma of the lung to the brain parenchyma and spinal cord that developed after chemotherapy and radiation therapy for uterine cervical carcinoma .
a 40-year - old female visited the gynecology department for evaluation of leg edema . abdominal computed tomography ( ct ) showed bilateral hydronephrosis and lymphadenopathy in the pelvic and para - aortic areas .
a punch biopsy of the erosive lesion of the uterine cervix revealed a combination of well - differentiated adenocarcinoma and small - cell carcinoma .
the histologic findings of the uterine cervix showed adenocarcinoma with an irregular glandular architecture and infiltration of small hyperchromatic tumor cells .
positron emission tomography ( pet ) showed the cervix and pelvic and para - aortic lymph nodes lesions . under a diagnosis of stage iiib cervical cancer , weekly cisplatin ( 40 mg / m )
follow - up pet carried out 5 months later showed extensive lymph node metastasis along the left paravertebral lymph nodes on the pelvic side .
after 1 year , pet and chest ct revealed multiple metastatic nodules in both lungs and subpleural nodules with vascular connections . a wedge resection of lung was performed .
gross findings of the specimen showed a 2.82.7-cm , well - circumscribed , whitish , firm , lobulated mass with hemorrhage and necrosis .
the histologic findings of the lung specimen revealed pulmonary basaloid carcinoma which lobulated solid tumor cell sheets with peripheral palisading and comedo type necrosis ( figure 1 ) .
five years later , she visited the clinic again complaining of headache and left hemiparesis .
brain magnetic resonance imaging ( mri ) showed a huge heterogeneous mass in the right parieto - occipital area ( figure 2 ) .
after the craniotomy and surgical resection of the lesion , patient recovered consciousness and hemiparesis , and the pathologic findings revealed pulmonary basaloid carcinoma .
whole - brain radiation therapy comprising a total dose of 5,500 cgy in 250 cgy daily fractions was administered postoperatively , and six cycles of chemotherapy with genexol and carboplatin was performed .
one year after the brain surgery , the patient began to suffer from right leg weakness followed by severe radiating pain on the same side and voiding difficulty .
we checked follow up brain ct which did not showed recurrence and lumbar mri showed an intramedullary tumor at the level of t12-l1 ( figure 3 ) .
she underwent gross removal of the spinal tumor through a t12-l2 hemilaminectomy ( figure 4 ) , and the pathologic findings revealed metastatic pulmonary basaloid carcinoma .
booster radiotherapy with a total dose of 4000 cgy in 300 cgy daily fractions was administered in the spine postoperatively .
unfortunately , five months later , she was transferred to the emergency room due to stuporous consciousness , and brain mri revealed multiple metastatic tumors in the cerebrum , cerebellum , and subependymal area .
reoperation was not feasible , and despite brain radiotherapy , the patient did not recover consciousness and died of brain swelling .
it also occurs in the skin , anus , tongue , larynx , and lungs.4 ) basaloid carcinoma of the lung was first reported by brambilla et al.5 ) in 1992 .
the overall survival rate of patients with cancer has rapidly increased due to the development of intensive multimodal therapies including immunosuppressive and cytotoxic therapies . however , as a result , it has brought about subsequent complications , especially the development of secondary malignant neoplasms , which has increased by 10 to 20 times.5 ) some authors reported metachronous tumors induced by radiation therapy.121012 ) the rate was higher among patients who received adjuvant radiation exceeding 40 gy , pointing out the possibility of secondary neoplasm development due to chemotherapy.3 ) in current case , the cell characteristics , including hyperchromatic nuclei , are the same in the lung , brain , and spinal cord based on the immunohistochemistry study , including cytokeratin 7 , etc .
it has been stated that the majority of spinal metastasis is connected to brain metastasis , and such seeding could thus easily occur.8 ) hematogenous spread is a hypothesis commonly accepted in the majority of studies .
one noteworthy hypothesis is that intraspinal metastasis is established as portacaval circulation and pulmonary circulation form bypass when coughing and sneezing through spread via a paravertebral plexus of veins ( batson 's vein plexus).9 ) in particular , the tumors that develop due to hematogenous spread are well defined and circumscribed such that they are discrete between the tumor and the spinal cord , thereby rendering them easy to eliminate.7 ) in current case , the border between metastatic tumor and cord was relatively discrete in mri finding and also in surgical field and other intraspinal canal lesion was not observed .
considering that the mean survival time among patients with brain metastasis is 12 to 15 months , surgical resection in patients with iscm and neurologic deficit is a delicate issue .
therefore , in determining the additional operation for the iscm of such patients should be seriously considered for ethical problem .
generally , the survival rate of patients with iscm who receive only radiation therapy is 4 months , whereas the average survival rate of those who receive both surgery and radiation therapy is 6 months.13 ) however , this is especially true in the patient described herein , who demonstrated a poor response to chemotherapy and radiation therapy .
the authors reported a metastasis case of metachronous pulmonary basaloid carcinoma that showed after chemotherapy and radiation therapy for cervical uterine carcinoma .
so there 's the possibility that a secondary pulmonary neoplasm developed due to the chemotherapy and radiotherapy conducted as cervical cancer treatment .
 multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency . 
 the authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma . 
 two different types of cancer developed within some interval . 
 there 's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment . 