Spinal cord compression as the initial presentation of colorectal cancer

Background: Malignant spinal cord compression (MSCC) is most frequently seen in patients with breast, prostate and lung cancer. Five percent to 25% of MSCC cases occur as the initial presentation of malignancy. Case report: We report the case of a 43-year-old male patient with sudden onset of incomplete paraplegia. Imaging revealed spinal cord compression at the level TH 3/4 and TH 8. Emergency decompressive surgery with tumour biopsy was performed. Two days after surgery, the patient developed large bowel obstruction, and a sigmoid tumour was identified as underlying cause. The sigmoid tumour was diagnosed as colorectal adenocarcinoma, and histological examination of the spinal tumour confirmed metastatic disease. Conclusion: MSCC may be the initial presentation in patients with neoplastic disease, and also tumours that only very rarely metastasize to the skeletal system have to be included in differential diagnosis. Obtaining biopsy material during surgery is crucial to establish a definitive diagnosis. 1 Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria 2 Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria 3 Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria Corresponding Author: Magdalena M. Gilg Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria Tel. +43 316 38514807 E-mail: [email protected] Spinal cord compression as the initial presentation of colorectal cancer Journal of Surgical and Molecular Pathology Volume 2, Issue 3, Page 2 Introduction Colorectal carcinoma is the third most common malignant tumour in males and the second one in females. Metastatic spread may be detected in virtually any organ, with the liver and the lungs being the most common sites [1]. Metastasis to the spine is a rare event and is considered to occur late in the disease course [2, 3]. Malignant spinal cord compression (MSCC) is one of the most serious complications of cancer and may be caused by nearly all types of malignancy but is most frequently seen in patients with breast, prostate, lung or renal cancer [4]. Between 5% to 25% of MSCC cases occur as the initial presentation of malignancy [2]. Herein, we report the case of a patient with colorectal cancer who presented with MSCC as the initial symptom.