Spinal metastasis of parotid acinic cell carcinoma followed by intradural extramedullary recurrence: illustrative case

J Neurosurg Case Lessons, 2021 · DOI: 10.3171/CASE21591 · Published: December 20, 2021

Simple Explanation

Acinic cell carcinoma (ACC) is a rare salivary gland cancer known for its ability to spread and recur, even many years after initial treatment. This case report describes a unique instance where ACC from the parotid gland metastasized to the spine, specifically within the spinal canal but outside the spinal cord itself. The patient, who had a history of ACC for 29 years, developed spinal cord compression due to the tumor's growth. After previous treatments had been exhausted, surgery was performed to remove the tumor and relieve the pressure on the spinal cord. This case highlights the rarity of intradural extramedullary metastases from parotid ACC and demonstrates that surgical intervention can improve neurological symptoms in such cases, even when other treatment options are limited.

Study Duration

Not specified

Participants

1 patient: 79-year-old male

Evidence Level

Illustrative Case

Key Findings

1
The patient presented with progressive cervical myelopathy 29 years after initial diagnosis of parotid ACC, indicating a rare late recurrence and metastasis.
2
MRI revealed an intradural extramedullary tumor at the C2-C3 level, which was initially suspected due to the lack of a 'curtain sign' and later confirmed intraoperatively.
3
Surgical resection of the tumor led to improved neurological function, demonstrating the potential benefit of surgical intervention even with limited treatment options.

Research Summary

This case report describes an extremely rare instance of intradural extramedullary (IDEM) metastasis of parotid acinic cell carcinoma (ACC) in a 79-year-old male with a 29-year history of the disease. The patient presented with progressive cervical myelopathy, and imaging revealed a tumor at the C2-C3 level with both extradural and intradural components. The tumor's intradural extension occurred 18 months after incomplete resection of an extradural metastasis at the same location. Despite limited treatment options due to exhausted systemic therapy and the inability to repeat radiation, surgical resection of the tumor resulted in improved neurological function, highlighting the potential benefit of surgical intervention in rare cases of IDEM metastasis from parotid ACC.

Practical Implications

Diagnostic Awareness

Clinicians should consider the possibility of IDEM metastasis in patients with a history of malignancy presenting with unexplained neurological symptoms, even years after the initial diagnosis.

Surgical Consideration

Surgical intervention can be a viable option for symptomatic relief and neurological function preservation in rare cases of IDEM metastasis, especially when other treatment options are exhausted.

Long-Term Follow-Up

Patients with parotid ACC require long-term follow-up due to the high likelihood of recurrence and late metastasis, even after treatment of the primary tumor and initial metastases.