Nerve root metastasis of gastric adenocarcinoma: A case report and review of the literature

Alessandra Di Sibio; Lucia Romano; Antonio Giuliani; Marco Varrassi; Maria Carmela De Donato; Antonio Iacopino; Marco Perri; Mario Schietroma; Francesco Carlei; Ernesto Di Cesare; Carlo Masciocchi

doi:10.1016/j.ijscr.2019.07.001

Nerve root metastasis of gastric adenocarcinoma: A case report and review of the literature

Int J Surg Case Rep. 2019:61:9-13. doi: 10.1016/j.ijscr.2019.07.001. Epub 2019 Jul 8.

Affiliations

¹ Department of Radiology, S. Salvatore Hospital, Via L. Natali, 1, 67100, L'Aquila, Italy.
² Department of Surgery, University of L'Aquila, L'Aquila, Italy; Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy. Electronic address: lucia.romano1989@libero.it.
³ Department of Surgery, University of L'Aquila, L'Aquila, Italy; Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
⁴ Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.

Abstract

Introduction: Nerve root metastasis without extension from an adjacent process has been seldom reported in case of solid tumors. We describe a case of solitary nerve root metastasis of gastric adenocarcinoma, likely due to hematogenous spread.

Case presentation: A 75-year-old man presented with radiculopathy refractory to medical treatment. MRI and CT demonstrated a right-sided S1 nerve root mass involving the spinal ganglion in its intra-foraminal region with avid enhancement, initial erosive bone changes on sacral foramina and focal hyperaccumulation on 18F - FDG CT-PET, suspicious for metastasis. The histopathological examination confirmed a metastasis of gastric adenocarcinoma.

Discussion: A review of the current literature revealed only ten cases of hematogenous metastases to spinal nerve root ganglia; the primary lesions in those cases were an oat cell carcinoma of the lung, two cases of colonic adenocarcinoma, a case of uterine adenocarcinoma, a ductal breast carcinoma, a Ewing's sarcoma, a Renal Cell Carcinoma, a gastro-intestinal stromal tumor, a follicular thyroid carcinoma, a pulmonary adenocarcinoma.

Conclusion: In the setting of a known malignancy, a nerve root metastasis should be considered in the differential diagnosis of a nerve root mass, although it occurs very rarely.

Keywords: Metastasis; Metastatic gastric cancer; Radiation therapy; Spinal nerve root ganglion neoplasm.