Intramedullary spinal cord metastasis from vaginal high-grade neuroendocrine carcinoma: A case report

Background: Intramedullary spinal cord metastases (ISCMs) from vaginal high-grade neuroendocrine carcinomas (VHNCs) are rare and may mimic primary intramedullary tumors or vascular lesions. Hereby, we report a 54-year-old female who presented with an ISCM attributed to a VHNC. Case Description: A 54-year-old female patient presented with a 1-month history of progressive left-predominant paraparesis, new-onset urinary incontinence, and constipation. She was previously diagnosed with a VHNC (i.e., small-cell carcinoma), with supraclavicular nodal metastasis, and had received cisplatin-etoposide chemotherapy 11 months earlier. The contrast-enhanced thoracolumbar magnetic resonance imaging (MRI) revealed an expansile intramedullary lesion at the T11–T12 level, with a focal, nodular, enhancing component, and surrounding edema. The patient subsequently underwent a near-total resection through a T11–T12 laminectomy. The postoperative MRI demonstrated a small residual lesion with an approximately 4-mm enhancing focus. Histopathology confirmed a metastatic high-grade neuroendocrine carcinoma consistent with the patient’s known vaginal primary. The patient’s neurological function had improved at the 3-month follow-up. Conclusion: ISCM may represent a critical neurologic complication of VHNC. Timely surgical decompression can facilitate neurological recovery and support multimodal oncologic management.