Lumbar Epidural Metastasis of Breast Cancer Resembling Lumbar Disc Herniation: a case report

Manabu Sasaki, Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan; Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan

Abstract
Background: As the prognosis of cancer patient has improved following advance in multimodal treatment, the incidence of metastases to distant organs commonly occur. Spinal metastatic tumor usually spread in spinal bone and sometimes induce paralysis through spinal cord compression. However, metastasis to the epidural space is rare. In this study, we report the metastasis of breast cancer to epidural space including intervertebral disc which seemed lumbar disc herniation at preoperative setting.
Case presentation: A 49-year-old woman who had breast cancer suffered from left leg pain. Initial MRI indicated lumbar disc herniation compressing S1 nerve root. The pain was uncontrollable with conservative treatments and she underwent surgical decompression. Intraoperative findings showed that left S1 nerve root was compressed by soft and gray tumor locating ventrally. We resected the nerve root surroundings and intervertebral disc protrusion, S1 nerve root was finally adequately decompressed. Pathological examination demonstrated adenocarcinoma as same as original breast cancer.
Conclusions: Intraoperative findings showed that bone tissue around the tumor was intact, it is thought to be metastasized to the epidural space hematogenously. Although lumbar disc herniation is much more popular than epidural metastasis, we should constantly consider differential diagnosis as metastatic lesion in case of malignancy.

Keywords
breast cancer, epidural metastases, lumbar disc herniation

Cite this paper
Takanori Fukunaga, Masao Umegaki, Yohei Bamba, Yasuaki Tsuchida, Koshi Ninomiya, Katsumi Matsumoto, Haruhiko Kishima, Manabu Sasaki, Lumbar Epidural Metastasis of Breast Cancer Resembling Lumbar Disc Herniation: a case report , SCIREA Journal of Clinical Medicine. Volume 7, Issue 3, June 2022 | PP. 159-166. 10.54647/cm32809

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