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Metastatic squamous cell carcinoma of the lung to the conus medullaris.

A 51-year-old male who had undergone left pulmonary lobectomy for squamous cell carcinoma followed by adjuvant radiotherapy and chemotherapy 3 months earlier was admitted for subacute onset of left lower limb paresthesias; proximal muscle weakness (2/5) in the left lower limb and distal muscle weakness in the right lower limb (2/5); urinary retention and constipation. Magnetic resonance imaging (MRI) of the spine demonstrated an intramedullary lesion in the conus medullaris, which was lateralized to the left and showed ring enhancement after contrast administration [Figure 1]. Image studies confirmed a solitary lesion as well as the primary disease to be under control. In view of these two factors, the patient was considered for surgical resection of the lesion with intraoperative neurophysiological monitoring. The patient underwent a T10-L1 laminectomy and a gross total resection of the tumor could be achieved. Pathological findings confirmed the diagnosis of intramedullary metastasis of squamous cell carcinoma. The patient showed improvement of muscle weakness (4/5 in both lower limbs) as well as sphincter control when he was discharged home. {Figure 1}