Intramedullary conus metastasis from carcinoma lung
A 46-year-old male had presented with progressive paraparesis associated with sensory impairment in both lower limbs since 2 months. He had incontinence of urine and stool. At the time of presentation he had flaccid paraplegia with a sensory level at 11th dorsal vertebral level (D11). One month prior to presentation to us, the patient had undergone an unsuccessful attempt at excision of the conus mass. Magnetic resonance imaging (MRI) of the dorsolumbar spine showed a discrete homogenously enhancing mass within the conus at the D12 level []. D11 to L1 laminectomies were noted []. The tumor was seen as on the earlier scan as it had not been biopsied. The previous midline incision over D11 to L1 was reexplored. The conus was exposed. A posterior midline myelotomy was performed on the conus at the site of the tumor bulge. A grey colored firm mass was noted. A gross total excision of the tumor could be achieved. Histopathology showed a poorly differentiated metastatic carcinoma []. There was cellular and nuclear atypia, mitotic activity, pleomorphism along with scattered bizarre cells. There were vascular emboli with areas of hemorrhage.\nThe patient underwent a positron emission tomography-computed tomography (PET-CT) scan of the whole body that revealed hypermetabolic activity in the hilum of the right lung. A review of the chest radiograph showed a right hilar lung mass, which had been missed earlier []. A CT guided biopsy of the hilar mass confirmed the diagnosis of lung adenocarcinoma.\nThe patient was advised chemotherapy for the primary and radiotherapy for the secondary spinal metastasis. At 1 month follow-up the patient was undergoing chemoradiation treatment. The patient had improvement in the motor functions of both lower limbs.