Pulmonary pleomorphic carcinoma with intrathecal metastasis: a case report.

Introduction: Pulmonary pleomorphic carcinoma (PC) is a rare and aggressive subtype of lung cancer. To date, spinal cord metastasis from pulmonary PC has not been reported.

Presentation of case: A 67-year-old woman was diagnosed with left upper lobe (LUL) lung tumor, and surgical pathology confirmed PC with spindle and giant cell components. Following surgery, she developed progressive paraparesis with ascending hypesthesia. Contrast-enhanced cervicothoracic spine MRI revealed direct invasion of the T1-T3 vertebrae and pedicles by the LUL tumor, resulting in spinal cord compression and paraspinal muscle involvement. Neurogenic shock subsequently developed, and the patient died 2 weeks later.

Discussion: Pulmonary PC is associated with a poorer prognosis than other non-small cell lung carcinomas. While it commonly metastasizes to the brain, bones, and liver, spinal cord involvement is exceedingly rare. Such metastasis can result in acute paraplegia, incontinence, and neurogenic shock, which increase mortality and lead to severe complications.

Conclusion: Although spinal cord metastasis is extremely rare in pulmonary PC, clinicians should maintain a high index of suspicion in patients presenting with new-onset neurological symptoms. Early MRI evaluation is crucial for prompt diagnosis and management, potentially improving outcomes and avoiding life-threatening complications.