14392              SECONDARY CARCINOMA (Primary kidney)

A man aged 75 was admitted with paraplegia from cord compression at the level of T5. Diagnosis was made difficult because he had an attack of myelitis or polyneuritis 4 years earlier and this led to the suspicion that he had a similar condition again. However X-ray of the spine showed erosion of the pedicle of T5 and myelogram showed a complete block at this level. At laminectomy a malignant tumour was found but the histology did not suggest the primary site. He did not improve after the operation and lingered for about 2 months before he died from hypostatic pneumonia. At postmortem a large fleshy tumour was found at the upper pole of the left kidney extending to involve the splenic flexure of the colon. Histology showed papillary adenocarcinoma consistent with a renal origin.

The specimen is of a length of thoracic cord to show a fleshy mass of secondary carcinoma adherent to the outer surface of the dura over a distance of 6 cms. There is congestion of small vessels on the inner surface of the dura and the cord at this level is shrunken. The tumour does not directly invade the substance of the cord and function has presumably been interrupted by occlusion of entering nutrient vessels.