INTRODUCTION - Perineural spread (PNS) is an unusual mechanism of tumor extension and has been typically reported in squamous cell carcinoma, adenocystic carcinoma or desmoplastic melanoma. Our group has previously demonstrated PNS in rectal, prostate, bladder and cervical cancer from the primary site along the autonomic nerves to the major somatic nerves and even intradurally.
We believe similar principles apply to renal cell carcinoma (RCC) as well, despite the different anatomy.
CASE DESCRIPTION - We performed a retrospective search to identify cases of intradural-extramedullary metastases of RCC caused by PNS. Strict anatomic and imaging inclusion criteria were defined: only lesions located between T6 and L3 were included, and PNS as a potential etiology had to be supported by imaging evidence. Although 3 cases of spinal intradural metastases were identified, only one met our strict inclusion criteria. A 61-year-old woman developed a late intradural-extramedullary metastasis of RCC 16 years after the original diagnosis that we believe represents an example of visceral organ PNS.
CONCLUSIONS - RCC can propagate via PNS from the primary tumor along the autonomic nerves to the aorticorenal, coeliac and mesenteric ganglia and then along the thoracic and lumbar splanchnic nerves to the corresponding spinal nerves and intradurally. We present radiologic evidence together with the review of the literature to support the premise that PNS of RCC not only occurs but goes unrecognized.
World neurosurgery. 2016 Feb 01 [Epub ahead of print]
Stepan Capek, William E Krauss, Kimberly K Amrami, Joseph E Parisi, Robert J Spinner
Department of Neurosurgery, Mayo Clinic, Rochester, 200 First St. SW, Rochester, MN, 55902, USA; International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic. , Department of Neurosurgery, Mayo Clinic, Rochester, 200 First St. SW, Rochester, MN, 55902, USA. , Department of Radiology, Mayo Clinic, Rochester, 200 First St. SW, Rochester, MN, 55902, USA. , Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55902, USA; Department of Neurology, Mayo Clinic, Rochester, 200 First St. SW, MN, 55902, USA. , Department of Neurosurgery, Mayo Clinic, Rochester, 200 First St. SW, Rochester, MN, 55902, USA.