Cauda equina compression associated with breast cancer. A case study in differential diagnosis

Area of Science:

• Oncology
• Neurology
• Radiology

Background:

• Spinal cord compression in cancer patients necessitates accurate etiological diagnosis for effective therapy.
• Metastatic disease is a common cause, but nonmalignant lesions can also present as spinal compression.
• Breast cancer patients with metastatic disease require careful evaluation to exclude nonmetastatic causes of compression.

Observation:

• A rare case of a 50-year-old woman with breast carcinoma and a concurrent spinal neurilemoma is presented.
• The neurilemoma mimicked a metastatic lesion, causing symptoms of pain, neurologic deficit, and weakness.
• This co-occurrence of breast carcinoma and spinal neurilemoma has not been previously reported.

Findings:

• Radiological imaging including roentgenograms, radionuclide bone scans, computed tomography (CT), and magnetic resonance imaging (MRI) aids in differentiating neurilemomas from metastatic lesions.
• Key radiologic features for identifying neurilemomas include their slow-growing nature and noninvasive boundaries.
• Biopsy remains the definitive method for confirming the diagnosis.

Implications:

• Accurate differentiation between metastatic and nonmalignant spinal lesions is critical for appropriate patient management.
• Prompt diagnosis and treatment, potentially including neurectomy and stabilization, can improve outcomes for patients with spinal cord compression.
• This case expands the differential diagnosis for spinal lesions in cancer patients, particularly those with breast carcinoma.