Female, 61 years old, with left arm weakness and right leg decreased pin prick, left arm and left leg weakness with hypotonia/hyperreflexia in the left arm. Brain:One or two scattered foci of T2 hyperintensity are evident within the cerebral hemispheres. No parenchymal edema or mass effect is detected. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is observed. No evidence of intracranial hemorrhage or abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A 4 mm focus of enhancement within the left aspect of the occipital bone is nonspecific. Elsewhere, signal characteristics of the marrow are unremarkable. A mucous retention cyst is present in the right maxillary sinus.Cervical spine:A T2 heterogeneous, homogeneously enhancing extra medullary mass is present within the left aspect of the spinal canal centered at C5. This lesion occupies approximately two thirds of the spinal canal and causes significant is compression of the adjacent spinal cord. Edema tracks within the spinal cord from the C3 level down to C7.The tumor itself extends craniocaudally within the spinal canal spanning from the mid C4 to the upper C6 levels. The inferior most margin of this lesion is T2 hypointense which may reflect mineralization or blood product. The lesion extends through the left C4-5 neural foramen, and even tracks for some distance laterally into the paraspinal musculature, likely following the course of the exiting nerve roots. The left vertebral artery abuts this lesion as it passes adjacent to the foramen and may be narrowed but the flow void does seem to be preserved.A small deposit of abnormal enhancing tissue is also seen within the left aspect of the thecal sac at the C4 level. This lesion is perhaps contiguous with minimal suspected tumor within the adjacent left C3-4 neural foramen.The cervical vertebral bodies demonstrate mildly heterogeneous marrow signal characteristics with scattered small areas of nonspecific marrow enhancement. Some or all of this may reflect degenerative disk disease prominently affecting the C4, C5 and C6 disk spaces and endplates.The cervical lordosis is reversed. Vertebral body heights are preserved. Vertebral morphology, accounting for degenerative disease, is otherwise unremarkable.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left paracentral disk osteophyte or perhaps thickened PLL causing mild mass effect on the ventral spinal cord. No significant generalized spinal canal stenosis. Cord signal is abnormal at this level due to tracking edema from below. The neural foramina are not significantly narrowed, allowing for the suspected tumor involvement of the left C3-4 foramen. C4-5: Right paracentral disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with marked cord compression and cord edema. Mild bilateral foraminal narrowing is seen along with tumor infiltration of the left C4-5 foramen.C5-6: Central disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with cord compression and edema. Moderate right and mild left neuroforaminal narrowing. C6-7: Central disk osteophyte or thickened PLL. No significant spinal canal or neuroforaminal stenosis.C7-T1: Unremarkable. Thoracic spine:A marrow replacing, homogeneously enhancing lesion is evident within the T1 vertebral body without evidence of epidural or extraosseous extension. Similar appearing smaller lesions are also seen within the left T4 vertebral body and pedicle, the left T7 pedicle and minimally scattered through the T5, T8, T9 and T10 vertebral bodies.At T11, significant marrow replacement and enhancement is seen within the left aspect of the vertebral body, pedicle and facet complex. The vertebral body is compressed centrally with at least 60% loss of height. Significant epidural disease extension is noted with encroachment upon the left lateral and ventral epidural space. This results in mild displacement of the spinal cord but no definite evidence of spinal cord compression or edema.A large lesion is also demonstrated within the T12 vertebral body without extraosseous spread or loss of vertebral body height. The partially visualized L1 vertebral body is also diffusely infiltrated and compressed. There is likely some epidural disease extension at this level as well, but it is only partially visualized.Except as discussed above, the thoracic spinal canal is patent. The spinal cord itself demonstrates normal morphology and signal characteristics. No pathologic intramedullary or leptomeningeal enhancement is clearly seen. No significant degenerative disk disease is identified. The left T10-11 and T11-12 neural foramina are mildly narrowed due to the epidural encroachment from T11.Tumor deposits are seen within the right supraclavicular fossa and right axilla. A tumor deposit is also evident within the left paraspinal musculature at the L1 level. This lesion protrudes into the abdominal cavity perhaps exerting slight mass effect on the adjacent left kidney.
An extramedullary, intracanalicular tumor is present centered at C5 spanning from C4 to C6. This lesion causes a severe cord compression with evidence of tracking cord edema.The above lesion extends in infiltrative fashion through the left C4-5 neural foramen into the adjacent paraspinal soft tissues. A small deposit of tumor is also suspected within the left lateral aspect of the spinal canal and left neural foramen at C3-4.Numerous tumor deposits are evident within the thoracic spine. At the T11 level, this is associated with significant epidural extension which causes spinal canal narrowing and a mild rightward displacement of the spinal cord but no frank cord impingement. A compression fracture of T11 is seen, as well as at L1.Soft tissue tumor deposits are evident in the right supraclavicular fossa, the right axilla and within the deep left paraspinal musculature at L1.No evidence of intracranial metastatic disease is seen.All the above lesions most likely represent metastatic disease from either the known breast or endometrial cancers. This constellation of findings would be a very atypical presentation for the patient's multiple myeloma, and this is therefore considered less likely.