Spinal pain due to metastasis of unknown origin

A 58-year-old woman presented with non-radicular pain in the upper thorax. Due to the prolonged duration of symptoms, a bone scintigraphy was made, which showed pathological enhancement in the upper thoracic spine. An MRI demonstrated lesions of the third and fourth thoracic vertebrae. A biopsy showed a metastasis of poorly differentiated carcinoma. A whole-body 18-F-FDG PET scan failed to identify a primary tumour. The patient was given radiotherapy, chemotherapy and analgesic treatment. She died within 3 years. In the late stage, the tumour marker CA 19-9 was positive; however, an MRI of the abdomen failed to identify a pancreatic tumour. Metastasis from an unknown primary site can present as cervical spinal disease very similar to degenerative disease.