Atypical presentation of a cervical breast-cancer metastasis mimicking a dumbbell-shaped neurinoma

Christoph Kolja Boese; Philipp Lechler; Jan Bredow; Nusaiba Al Muhaisen; Peer Eysel; Timmo Koy

doi:10.1016/j.ijscr.2014.06.019

Atypical presentation of a cervical breast-cancer metastasis mimicking a dumbbell-shaped neurinoma

Int J Surg Case Rep. 2014;5(10):689-93. doi: 10.1016/j.ijscr.2014.06.019. Epub 2014 Aug 11.

Authors

Christoph Kolja Boese¹, Philipp Lechler², Jan Bredow³, Nusaiba Al Muhaisen³, Peer Eysel³, Timmo Koy³

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany. Electronic address: christoph.boese@uk-koeln.de.
² Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Baldinger Straße, 35043 Marburg, Germany.
³ Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.

Abstract

Introduction: Spinal metastases are frequently encountered in patients with breast cancer. Because of recent improvements in oncologic therapies a growing incidence of symptomatic leptomeningeal metastases (LM) should be expected. The differential diagnosis of LM comprises a wide range of conditions, including neurinoma. The radiologic discrimination between metastases and neurinomas is primarily based on distinct neuroimaging features, particularly number, size and growth pattern.

Presentation of case: We report the first case of a solitary leptomeningeal metastasis of a cervical nerve-root, which mimicked a benign dumbbell-shaped neurinoma, using neuroimaging and visualized intraoperatively. The tumor was successfully treated with surgery followed by adjuvant radiochemotherapy (RCT).

Discussion: While the patient history directs towards a metastasis, the localization, growth pattern and MRI signal were concordant with a cervical neurinoma. The current literature is not conclusive concerning the optimal choice of treatment; the therapy is strictly palliative and indications for surgery remain individual decisions. However, due to recent improvements in survival of patients with LM require reconsideration of established strategies.

Conclusion: The present case report and the reviewed literature point towards a growing clinical relevance of symptomatic LM in cancer patients and their possible atypical presentations and locations.

Keywords: Breast cancer; Leptomeningeal metastasis; Neurinoma; Spinal metastasis.