847 - Atypical Presentation of Radiculopathy Secondary to Spinal Metastasis from Invasive Vaginal Carcinoma: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

MP

Meghna A. Patel, BS

Medical Student
mpate130@medsch.ucr.edu
Chino, California, United States
AC

Ahish Chitneni, DO

Resident Physician
NewYork Presbyterian - Columbia & Cornell
New York, New York, United States

Co-Author(s)

NA

Nasser Ayyad, DO

Assistant Professor in Clinical Rehabilitation Medicine
Weill Cornell Medical College
New York, New York, United States

Case Diagnosis: 70-year-old female with vaginal intraepithelial neoplasia III (VaIN III) with metastasis to the marrow, extension into the ventral epidural space, prevertebral space, and bilateral C6-C7 foramina.

Case Description: A patient with extensive history of abnormal Papanicolaou smears with total abdominal hysterectomy and bilateral salpingo-oophorectomy for cervical intraepithelial neoplasia III (CIN III) in 2005, high grade squamous intraepithelial lesions (7/2020), and VaIN III (9/2020) presented to the spine clinic (12/2022) with right arm pain extending from lateral bicep to lateral forearm and paresthesias to all right five fingertips. Massage and hot baths reportedly improve pain and paresthesias. The patient denies provoking factors, neck pain, or upper extremity weakness. All activities of daily living were maintained but with decreased tolerance. Exam revealed tenderness to palpation over the lateral aspect of the biceps, right brachioradialis, and right trapezius. Strength exam was 5/5 in bilateral upper extremities. Patient had a negative Spurling’s on the right, negative Tinel’s at the right cubital tunnel and carpal tunnel, and negative right Phalen’s test.

Discussions:

Results: MRI revealed a C7 spine compression fracture with possible marrow infiltration and extension into the ventral epidural space, prevertebral space, and bilateral C6-C7 foramina, along with left supraclavicular adenopathy. A subsequent PET scan suggested lung and cervical spine metastasis. Patient underwent a C7 laminectomy by neurosurgery followed by SBRT radiation to C7 by radiation oncology three weeks after presentation to the spine clinic.

Discussion: The patient’s case does not align with typical cervical radiculopathy. Right-arm pain and paresthesias are likely due to pathologic C7 fractures with retropulsion, resulting in severe canal stenosis and a likely infiltrative process extending into the left C6-C7 foramen.

Conclusions: Although this case of invasive vaginal carcinoma with metastasis to bone is rare, metastatic disease should be on the differential in patients with risk factors and neurologic symptoms.