Intradural spinal Wilm's tumor metastasis: case report.

OBJECTIVE

Wilm's tumor metastasis to the central nervous system (especially the spine) is rare. We present a case of a lumbosacral intradural drop metastasis in a male child with a remote history of intracerebral Wilm's tumor metastases.

CLINICAL PRESENTATION: A 7-year-old boy with known metastatic Wilm's tumor was discovered to have left frontal and parietal metastases. He subsequently underwent craniotomy and gross total resections of those lesions. Four years later, he developed low back pain and lower extremity weakness and was found to have an intradural lumbosacral lesion without intracranial recurrence.

INTERVENTION: The patient underwent lumbar laminectomy for resection of the intradural lesion. The tumor was found to be in the subarachnoid space and displaced the nerve roots of the cauda equina to the periphery of the thecal sac. The nerve roots were matted and encased within tumor tissue, thereby limiting the surgery to biopsy only. Postoperatively, the patient received radiation to the lesion. Unfortunately, follow-up imaging 4 months later revealed little tumor regression, and the patient's neurological condition did not improve significantly.

CONCLUSION

Spinal intradural Wilm's tumor metastases are rare. This is the only reported case in the literature of a probable drop metastasis from an intracerebral source. Although the optimal treatment for intra- or extradural Wilm's tumor spine metastases is not known, our patient did not make significant neurological improvement with radiation therapy.