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Subarachoid Seeding in a Breast Cancer Patient

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This was a woman who was complaining about

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paresthesias in both the upper extremities,

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as well as the lower extremity.

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And the patient was requested for complete

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spine evaluation, as well as the brain.

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The brain was unremarkable. On the spinal

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images, we have the T1-weighted scan,

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the STIR image in the center,

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and the T2-weighted scan.

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On the initial evaluation,

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it was a little bit peculiar in that the

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spinal cord seemed to have an unusual contour

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and was tented posteriorly in one location in

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the mid thoracic region. But in general,

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not much was suspected.

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And when we did the axial T2-weighted

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scans through the spinal cord, again,

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there were some unusual contour features of

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the spinal cord, in that it was a little bit

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flattened in some areas and had a funny shape to it,

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but we really weren't suspecting all that much.

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We thought maybe this was arachnoidal

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adhesions, possibly from lumbar puncture.

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And we went through this scan and said, you know, well,

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not looking too much, you know,

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maybe from, you know, previous instrumentation

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and arachnoid adhesions.

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And then we came to the post-gadolinium

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enhanced images. Wow.

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So here you see, on the surface of the

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spinal cord contrast enhancement,

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both anteriorly as well as posteriorly in the

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cervical region. In the thoracic region,

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that tenting that we described previously,

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you can see, again posteriorly,

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but there are little nodules of enhancement in

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addition to sort of sugar coating of the

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spinal cord with contrast enhancement.

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And then in the lumbar region,

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we see very thick enhancement of the cauda equina

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nerve roots throughout the lumbar

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region. So going back through the history,

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this patient turned out had breast cancer.

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So this is an example of subarachnoid seeding

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in a woman who has had breast cancer, in which

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there is both sugar coating or candle

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guttering of the spinal cord,

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as well as more focal nodularity leading to

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the scarring and tenting of the

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spinal cord posteriorly,

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as well as cauda equina nerve root seeding.

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And this was the abnormality that was

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accounting for the patient's upper and lower

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extremity paresthesias. Once again,

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in this situation,

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I would recommend scanning the brain and

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making sure that there is not a parenchymal

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enhancement in the brain that could be the

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source for the subarachnoid seeding.

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Because parenchymal lesions that shed in the CSF are a

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more common source of subarachnoid seeding

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in breast cancer than de novo

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seeding of the subarachnoid space

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without a parenchymal lesion.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neoplastic

Musculoskeletal (MSK)

MRI

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