Late occurrence of drop metastasis to the spine in a case of esthesioneuroblastoma

Case report

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Esthesioneuroblastoma is an aggressive neuroectodermal tumor that originates from the olfactory mucosa and often recurs locally. Distant metastasis of esthesioneuroblastoma has been described, but there are few reports of drop metastasis to the spinal cord. Here, we report a case of multiple drop metastases to the cervical, thoracic, and lumbar regions of the spinal cord that occurred 18 years after resection and radiotherapy of the original anterior cranial fossa lesion. There was no evidence of local recurrence. The symptomatic lesion was treated with resection and adjuvant chemotherapy. The options available for treatment of this disease are summarized with a review of the few reported cases of spinal metastasis of esthesioneuroblastoma.

Article Information

Address correspondence to: Brian T. Ragel, M.D., Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Avenue, CH8N, Portland, Oregon 97239. email: ragelb@ohsu.edu.

Please include this information when citing this paper: published online July 29, 2011; DOI: 10.3171/2011.6.SPINE11157.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Sagittal T1-weighted MR image of the cervical spine showing 2 intradural extramedullary masses that extend into the spinal canal and displace the spinal cord. B: Sagittal T2-weighted MR image obtained after administration of contrast agent showing that both masses enhance homogeneously. C: Axial T1-weighted sequence obtained before contrast enhancement showing that the mass centered at C-5 appears ventrally based and invades the right neuroforamen. D and E: Contrast-enhanced sagittal T1-weighted sequences of the thoracic and lumbar spine showing multiple intradural extramedullary masses that also intensely enhance homogenously. These masses do not demonstrate any nerve root involvement or spinal canal compromise. F: Gadolinium-enhanced coronal MR image showing small enhancing dural-based nodules superficial to the right parietal lobe and left cerebellar hemisphere. No evidence of recurrence was observed in the anterior cranial fossa. G–I: Sagittal precontrast (G), sagittal postcontrast (H), and axial precontrast (I) T1-weighted images of the cervical spine obtained at 9 months after the operation described in this article showing a residual ventral dura–based mass centered at the C-5 level, associated with slight displacement of the spinal cord to the right and enhancement along the left C-4 nerve root. The ventral lesion at the level of C-2 is stable in size compared with preoperative images.

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    Photomicrographs of sections from the mass at C4–6. Hematoxylin and eosin staining shows that the tumor is composed of well-defined nests and lobules of cells separated by a fibrovascular stroma (A). The neoplastic cells consisted of 2 distinct groups: one group had vesicular nuclei and single nucleoli (B) and the other had darker and coarser chromatin (C), prone to considerable crush artifact. Microcalcifications were present. Mitoses were rare, and necrosis was not identified. Gland formation was not present. Neurofibrillary matrix and rosette formation were not prominent. Results of immunohistochemical staining for the neuronal markers synaptophysin (D) and CD56 (E) were positive, whereas results of staining for keratin were negative (F). Original magnification × 100 (A), 400 (B–D and F), and 200 (E).

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