Cervical intramedullary spinal cord metastasis from esophageal cancer

Intramedullary spinal cord metastasis (ISCM) of malignant tumors is extremely rare. More than half of the primary sites of ISCM are lung cancer, followed by breast cancer and malignant melanoma. To the best of our knowledge, there are very few reports of ISCM from esophageal cancer. A 78-year-old male was diagnosed with esophageal squamous cell carcinoma in the middle thoracic esophagus. He underwent esophagectomy after effective neoadjuvant chemoradiotherapy. Two months later, he developed diplegia and respiratory failure. Magnetic resonance imaging showed an intramedullary spinal cord tumor at the C2 level of the spinal cord, and we diagnosed ISCM from esophageal cancer. The patient died of respiratory failure 20 days after onset. Even though induction therapy is very effective for advanced cancer, metastasis to the central nervous system may occur as the blood-brain barrier shuts off the drug delivery. When we determine the indication for conversion surgery, we have to keep the possibility of such rare types of metastasis in mind.