Intraspinal metastatic neuroendocrine carcinoma:a case report

LI Dong; LIU Hong-jun; QI Jian; HOU Xiong-feng

doi:10.13798/j.issn.1009-153X.2024.11.013

Abstract：Neuroendocrine tumors(NETs)are a kind of rare and highly heterogeneous epithelial tumors,mainly manifested in the digestive system and lungs.The most common metastatic sites are the liver,lungs and lymph nodes,while intraspinal metastasis is relatively rare.This paper presents a case of intraspinal metastatic neuroendocrine carcinoma in a 69-year-old male.The patient was admitted to the hospital due to substernal pain lasting for 3 months and sudden motor dysfunction of both lower extremities for 20 hours.Imaging examinations indicated abnormal signals in the T8 vertebra on thoracic spine MRI,accompanied by an extramedullary epidural space-occupying lesion in the spinal canal;and patchy slightly high-density shadows in the L4 vertebra and bilateral iliac bones on lumbar spine CT.Laboratory tests disclosed a significantly elevated level of serum neuron-specific enolase.Subsequently,an extramedullary epidural lesion resection within T7～T8 was conducted under general anesthesia.Intraoperative observations revealed that the lesion was located in the extramedullary epidural space of the T7～T8 spinal canal,without a distinct capsule,being solid and fish-like in shape,situated on the ventral side of the dural sac,occupying the majority of the spinal canal space and pushing the dural sac posteriorly.The postoperative pathological diagnosis was grade Ⅲ metastatic neuroendocrine tumor.Despite the surgical treatment,the patient's symptoms did not improve.The family requested an automatic discharge and the patient died two months after the operation.In view of the difficulty in diagnosing the primary lesion of intraspinal metastatic tumors,it is suggested to consider using PET-CT scans in clinical practice for assistance in diagnosis.The prognosis of intraspinal metastatic NET is typically poor,and whether surgery can enhance the prognosis of patients remains to be further investigated.