Abstract
Renal cell carcinoma (RCC) intramedullary spinal cord metastasis (ISCM) is a rare but frequently devastating diagnosis. Due to its rarity, there is currently no clear standard of care for RCC ISCM management. However, with improvements in metastatic RCC management and imaging for early detection of ISCM, we may see a rise in the incidence of RCC patients developing ISCM, for which treatment guidelines are lacking. Here, we aim to add to the growing body of RCC ISCM literature with two cases- one with ISCM managed with surgery, radiation, and immunotherapy, and the other managed with only radiation, immunotherapy, and chemotherapy. Case 1 is a 47 year old male with RCC and lung and bone metastases who underwent nephrectomy, lobectomy, high dose IL-2 therapy, and immunotherapy. He later developed worsening low back pain, and lower extremity paresthesias and weakness. Imaging revealed a thoracic metastasis for which he was started on steroids, underwent surgical resection followed by radiation therapy, and immunotherapy. Serial imaging and clinical exams have not found evidence of ISCM recurrence 5 years after initial resection. Case 2 is a 74 year old female with RCC with cerebellar metastasis who underwent nephrectomy, suboccipital craniotomy with mass resection, radiation therapy, and immunotherapy. 3 years later, she developed neck pain with right arm paresthesias, and imaging revealed cervical spine ISCM. Patient declined surgical intervention, and she was managed with steroids and radiation therapy, followed by chemotherapy. Approximately 5 years after initial ISCM findings, serial imaging and clinical exams have not revealed evidence of disease progression. These cases have several important differences including prior central nervous system metastases, ISCM location, and surgical intervention. However, both have not shown evidence of disease progression at similar time points. We hope these cases add to the small body of cases to move towards developing treatment guidelines.