{"paper_id":"485e5f6d-e0ad-46cc-9983-91df3bb0d019","body_text":"Rapidly progressive Intramedullary Spinal Cord Metastases from Breast Cancer: a case report and review of the literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rapidly progressive Intramedullary Spinal Cord Metastases from Breast Cancer: a case report and review of the literature Zhongqiang Hu, Huiyan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9064543/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Breast cancer is one of the most common malignant tumors in women. Distant metastases are most frequently seen in the lung and bone, whereas intramedullary spinal cord metastasis ( ISCM ) is extremely rare. Herein, we report a rare case of ISCM from breast cancer. Case presentation： A 67-year-old female was diagnosed with breast cancer 3.5 years ago and received standardized systemic treatment. Unfortunately, 2 years later, she developed lung and brain metastases. Recently, she was diagnosed with ISCM due to sensory and motor dysfunction of both lower extremities, and underwent surgical treatment. Within 24 hours postoperatively, her sensory level gradually decreased and finally stabilized at the L3 level, but no significant recovery in muscle strength or tone was observed. Conclusions: ISCM from breast cancer is an extremely rare, rapidly progressive, and devastating complication with an extremely poor prognosis. The overall survival remains dismal for most patients. Further accumulation of clinical cases and high-quality studies are warranted to establish optimal diagnosis and treatment protocols for this rare condition. Neurology Breast cancer Intramedullary spinal cord metastasis Metastatic tumor Surgical treatment Figures Figure 1 Figure 2 Background Breast cancer is one of the most common malignant tumors in women worldwide, with high incidence and mortality rates[ 1 ]. With the development of standardized comprehensive treatments including surgery, chemotherapy, targeted therapy, and immunotherapy, the prognosis of patients with early‑stage breast cancer has been significantly improved[2.3]. However, distant metastasis remains the leading cause of treatment failure and death in breast cancer patients[ 4 ]. The most frequently involved metastatic sites include the lung, bone, liver, and brain, while ISCM is extremely rare[ 5 ]. ISCM secondary to breast cancer is associated with an extremely aggressive clinical course and dismal prognosis. In recent years, with the widespread application and continuous advancement of magnetic resonance imaging (MRI), the detection rate of ISCM has increased gradually[6.7]. Nevertheless, due to its low incidence and atypical clinical manifestations, the diagnosis of ISCM is often delayed, leading to rapid neurological deterioration such as limb weakness, sensory disturbance, and even paralysis[ 8 ]. At present, there is no uniform standard guideline for the diagnosis and treatment of breast cancer‑associated ISCM. Treatment strategies mainly include surgical resection[ 9 ], radiotherapy[ 10 ], chemotherapy[ 11 ], steroid hormone[ 12 ], and supportive care, but the optimal therapeutic schedule remains controversial. Herein, we report a 67‑year‑old female patient with breast cancer who developed rapidly progressive ISCM at the T11–T12 level, accompanied by acute neurological dysfunction. We retrospectively analyzed her clinical manifestations, imaging features, pathological characteristics, surgical treatment, and prognosis. Combined with a review of the relevant literature, we aim to improve the understanding of early diagnosis and individualized treatment of this rare disease. Case presentation The patient was a 67-year-old female. She underwent surgery for a left breast mass approximately 3.5 years ago. Postoperative pathology revealed invasive ductal carcinoma of the breast (histological grade III, 3 + 3+2). Immunohistochemistry: ER(-), PR(-), Her-2(0). Based on the pathology, she received 4 cycles of EC-T regimen chemotherapy 20 days after surgery and was discharged smoothly, with regular follow‑up thereafter. Two years later, chest CT showed progressive enlargement of multiple nodules in the right lower lobe, accompanied by lymphadenopathy in the right hilum and anterior mediastinum. Percutaneous needle biopsy confirmed pulmonary metastasis of breast cancer (poorly differentiated). Immunohistochemistry: ER(-), PR(-), HER-2(1+), GATA-3(+), CK7(+), P120(membrane+), TIF-1(-), NapsinA(-), Ki-67 (positive rate approximately 70%). She then received scheduled chemotherapy regimens: docetaxel + carboplatin, followed by nab-paclitaxel + camrelizumab (immunochemotherapy). Over the past year, the patient gradually developed numbness of hands and feet, paroxysmal headache and distension, and lower extremity weakness. Brain MRI suggested possible brain metastasis from breast cancer, and she underwent radiotherapy with a smooth course. Follow-up brain MRI showed the lesions were smaller and fewer than before. Subsequently, she received targeted chemotherapy with bevacizumab + gemcitabine + cisplatin. Recently, the patient complained of low back pain with obvious sensory and motor disturbances in both lower extremities. Thoracolumbar MRI revealed an intramedullary space‑occupying lesion at the T11–T12 vertebral level. Physical examination showed: Muscle strength of both lower extremities: approximately grade III. Slightly decreased muscle tone. Diminished superficial and deep sensation, more obvious on the left side. Three days later, the patient’s sensory and motor functions of both lower extremities deteriorated rapidly. Examination revealed flaccid paralysis of both lower extremities with muscle strength grade 0. The sensory level was approximately at T11 on the left and L1 on the right. An emergency operation was performed to resect the intramedullary spinal cord mass. Postoperative pathology and immunohistochemistry confirmed intramedullary metastasis of breast cancer. Immunohistochemistry: CK5/6(focal +), CK7(+), GATA-3(+), GFAP(-), Oligo-2(-), P40(-), TRPS1(+), Villin(-). Postoperatively, the patient was treated with methylprednisolone sodium succinate 80 mg as a pulse therapy. Within 24 hours, the sensory level gradually descended and finally stabilized at the L3 level, but no significant recovery of muscle strength or tone was observed. Discussion and Review of Literature ISCM represents an extremely rare and devastating complication of systemic malignancies, among which breast cancer is one of the most common primary tumors responsible for ISCM[ 13 ]. Owing to its low incidence, atypical clinical manifestations and rapid neurological progression, ISCM is prone to delayed diagnosis or misdiagnosis in clinical practice, which frequently results in severe neurological dysfunction and an extremely dismal prognosis. In the present study, we reported a 67-year-old female patient with triple‑negative breast cancer who developed rapidly progressive ISCM at the T11‑T12 level accompanied by acute flaccid paralysis of bilateral lower extremities. Combined with a systematic literature review over the past decade, we analyzed the clinical characteristics, treatment modalities and prognostic factors of breast cancer‑associated ISCM, aiming to provide evidence for early diagnosis and individualized comprehensive management. We retrieved a total of 201 articles published in the past decade using the search strategy: (Breast Cancer) AND (((Metastasis) AND ((Intramedullary) OR (Spinal Cord))) OR (intramedullary spinal cord metastases)). A total of 22 articles were initially screened by reviewing the titles and abstracts, and their full texts were retrieved. Among them, 3 articles were unavailable. After carefully reading the remaining 19 full-text articles, 12 studies involving 14 patients were finally included in this literature review. Table I. Studies included in systematic review Survival 1month 1.5month 3month 4month 3month Outcome Dead Improved Dead Dead Improved Deteriorated Improved Improved Deteriorated Improved Improved Deteriorated Dead Dead Type of Treatment RT 、chemotherapy RT Surgery RT 、Steroid hormone RT 、chemotherapy 、 Steroid hormone Steroid hormone Surgery RT 、Steroid hormone Surgery RT 、Trastuzumab Surgery、RT 、Steroid hormone Surgery、Steroid hormone Surgery RT 、chemotherapy Interval from Primary tumor to ISCM diagnosis diagnosis 24month 24month 72month Initial symptom Initial symptom 24month 264month Not reported Not reported 60month 32month 133month 17month 3month Metastases to other organs N Bone 、Liver、 Lung、 Brain、 Axillary lymph nodes Brachial plexus N Liver T7−10 vertebral body Local recurrence Brain Not reported Bone、 Liver、 Brain Not reported Brain Rib、 Brain N Localization T11-T12 C6-T2 C6-C7 T11-T12 C2-C3 T7-T8 Conus medullaris and Cauda equina C4 T6 C7 T12 L1 L4 C2 C2 T3 T11 C6-C7 Sex F F F F F F F F F F F F F F Age 30 60 70 42 45 53 66 62 43 37 53 48 50 38 No. of patients 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Country Tunisia Italy UK Tunisia Turkey Japan USA France USA Japan USA Morocco Year 2024 2017 2020 2025 2016 2016 2020 2021 2022 2024 2018 2021 First Author Wala Ben Kridis[ 11 ] Dario Aiello[ 10 ] N Jayakumar[ 9 ] Nadia Bouattour[ 14 ] Coskun Ozturker[ 15 ] Terufumi Kawamoto[ 12 ] Charles E Mackel[ 16 ] Marion Tonneau[ 17 ] Eric Feldstein[ 18 ] Hiroaki Yamane[ 19 ] Ben A Strickland[ 20 ] M Hommadi[ 21 ] Study design Case report Case report Case report Case report Case report Case report Case report Retrospective study Case report Case report Retrospective study Case report No 1 2 3 4 5 6 7 8 9 10 11 12 All 14 patients were female, with an age range of 30–70 years (mean 49.786 ± 11.676 years), indicating that middle-aged and elderly women are the main affected population. Geographically, the reported cases were distributed across multiple countries, with the United States accounting for the largest proportion(35.71%), followed by Japan༈14.29%༉ and Tunisia༈14.29%༉. Among the included studies, case reports accounted for the majority༈71.43%༉, while retrospective studies were relatively few༈35.71%༉, which further confirmed the rarity and sporadic characteristics of this disease. Regarding lesion distribution, most patients presented with a single intramedullary lesion involving multiple segments(85.71%), and only 2 patients had multiple metastatic lesions༈14.29%༉, with the highest number of involved segments reaching four. The cervical spinal cord was the most common site༈46.43%༉, followed by the thoracic segment༈42.86%༉, which was slightly different from the distribution characteristics of ISCM reported in previous studies[22.23]. In our case, the lesion was located at the T11-T12 thoracic spinal cord, which is a common predilection site. In addition, most patients had other systemic metastases༈64.29%༉, including 5 cases with central nervous system metastases (35.71%), suggesting that breast cancer patients with a history of intracranial metastasis should be alert to the possibility of concurrent spinal cord metastasis. The time interval from the diagnosis of primary breast cancer to the occurrence of ISCM varied greatly, ranging from 3 to 144 months (mean 53.300 ± 49.273 months), and a small number of patients(14.29%) initially presented with ISCM as the first clinical manifestation. This suggests that ISCM can occur at any stage of breast cancer, and clinicians should maintain long-term follow-up and vigilance even in patients with stable conditions. In terms of treatment, there is still no unified standard guideline. Monotherapy༈42.86%༉ and combined therapy༈57.14%༉ were used in clinical practice, among which surgical resection༈42.86%༉and radiotherapy༈57.14%༉ were the most common local treatments.In addition, 42.86% of the patients received steroid therapy. No statistically significant difference in patient prognosis was observed between the different treatment modalities. This finding may be partly explained by the relatively small number of cases enrolled in the present study. In our patient, emergency surgical resection was performed due to rapid neurological deterioration, supplemented with steroid therapy postoperatively. Partial relief of neurological symptoms was achieved after surgery, indicating that timely surgical decompression may help to rescue residual neurological function. Table II. The relationship between different therapeutic regimens and prognosis. Monotherapy Combined Therapy X² P Improved 2 4 0.250 0.682 Deteriorated / Dead 4 4 The overall prognosis of patients with breast cancer-related ISCM was unsatisfactory. Half of the patients had poor outcomes, including death (35.71%) or aggravated neurological symptoms(14.29%), and the median survival time of deceased patients was only 2.5 months. This reflects the highly aggressive nature of ISCM and the limited efficacy of current treatments. Early imaging screening, precise pathological diagnosis and multidisciplinary comprehensive treatment may help to improve the clinical outcomes of such patients. Conclusion In summary, ISCM from breast cancer is an extremely rare, rapidly progressive, and devastating complication with an extremely poor prognosis. Based on our case report and literature review of 14 patients in the past decade, this entity predominantly affects middle-aged and elderly female patients, with single lesions most commonly seen in the cervical and thoracic spinal cord. A considerable proportion of patients have a history of other systemic metastases, often accompanied by involvement of the central nervous system. At present, there is no standardized treatment guideline, and surgical resection, radiotherapy, and combined comprehensive therapy are the main therapeutic strategies. Early recognition based on clinical manifestations and MRI findings, as well as timely multidisciplinary intervention, may help alleviate neurological deterioration. However, the overall survival remains dismal for most patients. Further accumulation of clinical cases and high-quality studies are warranted to establish optimal diagnosis and treatment protocols for this rare condition. Declarations Ethical Approval This case report does not constitute human subject research requiring ethics approval. However, the study adhered to the ethical principles outlined in the Declaration of Helsinki. Consent for Publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor- in-Chief of this journal. Data Availability Statement The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding None. Acknowledgements None. Authors’contributions Zhongqiang Hu: case collection and organization, analysis of imaging data and Pathological sections, article writing and revision; Huiyan Wang: case organization, feasibility analysis of article writing, paper review and proofreading. The authors declare no competing interests. Ethical Guidelines Relevant guidelines and regulations were in effect for all methods. References Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36cancers in 185 countries[J]. CA Cancer J Clin 74(3):229–263 The Society of Breast Cancer China Anti-Cancer Association Guidelines for breast cancer diagnosis and treatment by China AntiCancer Association(2026 edition)[J]. China Oncology,2025,35(12): 1157–1254 William J, Gradishar MS, Moran J, Abraham et al (2024) Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw 22(5):331–357 Zhang Y, Asad S, Weber Z et al (2021) Genomic features of rapid versus late relapse in triple negative breast cancer[J]. BMC Cancer 21(1):568 Lv J, Liu B, Quan X et al Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review[J]. Onco Targets Therapy 2019 Jun 21:12:4741–4753 Phong Dam-Hieu, Seizeur R, Mineo J-F et al (2009) Retrospective study of 19 patients with intramedullary spinal cord metastasis[J]. Clin Neurol Neurosurg 111(1):10–17 Lee SS, Kim MK, Sym SJ et al (2007) Intramedullary spinal cord metastases: a single-institution experience[J]. J Neurooncol 84(1):85–89 Takeshi Nishimura H, Yamazaki G, Suzuki et al (2022) Palliative Radiation Therapy for Intramedullary Spinal Cord Metastasis[J]. Cancer Diagn Progn 2(6):702–706 Jayakumar N, Ismail H, Athar S et al (2020) Perineural invasion in intramedullary spinal cord metastasis[J]. Ann R Coll Surg Engl 102(5):e94–e96 Dario Aiello R, Mazzola F, Gregucci et al (2017) Surprising complete response of intramedullary spinal cord metastasis from breast cancer: a case report and literature review[J].Tumori. 103(Suppl 1):e28–e30 Kridis WB, Nefzi I, Souissi B et al (2024 May) Intramedullary spinal cord metastasis from breast cancer: an ambiguous entity[J]. BMJ Support Palliat Care 2:spcare–2024 Terufumi Kawamoto T, Yamashita S, Kaito et al (2016) Intramedullary Spinal Cord Metastasis from Breast Cancer Mimicking Delayed Radiation Myelopathy: Detection With (18)F-FDG PET/CT[J]. Nucl Med Mol Imaging 50(2):169–170 Takeshi Nishimura H, Yamazaki G, Suzuki et al (2022) Palliative Radiation Therapy for Intramedullary Spinal Cord Metastasis[J]. Cancer Diagn Progn 2(6):702–706 Nadia Bouattour S, Sellami Y, Mzid et al (2025) Intramedullary spinal cord metastasis presenting as the initial manifestation of breast cancer: case report and review of the literature[J]. Spinal Cord Ser Cases 11(1):13 Coskun Ozturker AK, Sivrioglu HO, Sildiroglu et al (2016) Breast cancer presenting with intramedullary cervical spinal cord metastasis[J]. Spine J 16(7):e463–e464 Charles E, Mackel G, Alsideiri EP (2020) Intramedullary-Extramedullary Breast Metastasis to the Caudal Neuraxis Two Decades after Primary Diagnosis: Case Report and Review of the Literature[J]. World Neurosurg Aug:140:26–31 Tonneau M, Raphaëlle, Mouttet-Audouard F, Le Tinier et al (2021) Stereotactic body radiotherapy for intramedullary metastases: a retrospective series at the Oscar Lambret center and a systematic review[J]. BMC Cancer. ;21(1):1168 Feldstein E, Li B, Kim M et al (2022 Jun) Resection of Thoracic Intramedullary Breast Metastasis Through the Dorsal Root Entry Zone: 2-Dimensional Operative Video[DB/OL]. World Neurosurg 162:9 Hiroaki Yamane T, Itagaki K, Kajitani (2024) Trastuzumab Deruxtecan for HER2-Positive Breast Cancer with Central Nervous System Metastasis[J]. Case Rep Oncol 18(1):22–28 Ben A, Strickland IE, McCutcheon I, Chakrabarti et al (2018) The surgical treatment of metastatic spine tumors within the intramedullary compartment[J]. J Neurosurg Spine 28(1):79–87 Hommadi M, Belemlih M, Marnouch E et al (2021) Intramedullary spinal cord metastases: Report of three cases and review of the literature[J]. Cancer Radiother 25(2):169–174 Motoyuki Iwasaki K, Naito T, Endo et al (2023) Impact of surgical treatment for intramedullary spinal cord metastasis on neurological function and survival: A multicenter retrospective study by the Neurospinal Society of Japan[J]. J Clin Neurosci Nov:117:27–31 Salvotti HV, Lein A, Proescholdt M et al (2024) Characteristics and Outcome of Surgically Treated Patients with Intradural Extra- and Intramedullary Spinal Metastasis-A Single-Center Retrospective Case Series and Review[J]. Curr Oncol 31(7):4079–4092 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9064543\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":602603599,\"identity\":\"f7f8020a-e65f-45e2-b3fa-3930fb2fb89d\",\"order_by\":0,\"name\":\"Zhongqiang Hu\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACAwYG9g8JFf/k2NjbDxCthY3hw5kDxnw8ZxKI18I4s+1A4jwJBwPitJjzH972mIftTnqbBEMCw4+KbYS1WDYcKzfm4XmW2ybdeICx58xtIhx2sMdAmkeCObdN5kACM2MbMVoO8wC1GDCns0kkGBCp5RiPmeSMhMMJJGg5w1Zs8OFAmmEbMJAPEueX84c3Pkj8ZyMv395+8MGPCiK0MICjBgoOEKUeRcsoGAWjYBSMAqwAABJoPeZw6H6bAAAAAElFTkSuQmCC\",\"orcid\":\"https://orcid.org/0009-0009-7610-4088\",\"institution\":\"Jinan Third People’s Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Zhongqiang\",\"middleName\":\"\",\"lastName\":\"Hu\",\"suffix\":\"\"},{\"id\":602603600,\"identity\":\"7a191bd4-2dd1-4cc9-b768-687edf3a0f53\",\"order_by\":1,\"name\":\"Huiyan Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong Public Health Clinical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Huiyan\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-08 13:38:18\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":false,\"vertebrateSubjects\":true,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":false,\"humanSubjectConsent\":false,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":false,\"vertebrateSubjectEthicalGuidelines\":true},\"doi\":\"10.21203/rs.3.rs-9064543/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9064543/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104341285,\"identity\":\"0c8fc77c-10d3-41fa-969a-a8d35ddee6a8\",\"added_by\":\"auto\",\"created_at\":\"2026-03-10 16:48:09\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":172321,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eUnnumbered image in the Case presentation section.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9064543/v1/34f019b55dbb5401daf0e02e.jpg\"},{\"id\":104779885,\"identity\":\"0b65bf56-1182-4f0d-b531-e9be0c254007\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 07:47:24\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":247965,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eUnnumbered image in the Case presentation section.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9064543/v1/9238a1cfc04c378c99530206.jpg\"},{\"id\":104784203,\"identity\":\"4bb40095-984f-4d16-ad33-82597469ab7c\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 08:05:37\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":951695,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9064543/v1/8ea4027a-cc32-4963-9e5b-1a5f50e0eb6d.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eRapidly progressive Intramedullary Spinal Cord Metastases from Breast Cancer: a case report and review of the literature\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eBreast cancer is one of the most common malignant tumors in women worldwide, with high incidence and mortality rates[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. With the development of standardized comprehensive treatments including surgery, chemotherapy, targeted therapy, and immunotherapy, the prognosis of patients with early‑stage breast cancer has been significantly improved[2.3]. However, distant metastasis remains the leading cause of treatment failure and death in breast cancer patients[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The most frequently involved metastatic sites include the lung, bone, liver, and brain, while ISCM is extremely rare[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. ISCM secondary to breast cancer is associated with an extremely aggressive clinical course and dismal prognosis. In recent years, with the widespread application and continuous advancement of magnetic resonance imaging (MRI), the detection rate of ISCM has increased gradually[6.7]. Nevertheless, due to its low incidence and atypical clinical manifestations, the diagnosis of ISCM is often delayed, leading to rapid neurological deterioration such as limb weakness, sensory disturbance, and even paralysis[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. At present, there is no uniform standard guideline for the diagnosis and treatment of breast cancer‑associated ISCM. Treatment strategies mainly include surgical resection[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], radiotherapy[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], chemotherapy[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], steroid hormone[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e], and supportive care, but the optimal therapeutic schedule remains controversial. Herein, we report a 67‑year‑old female patient with breast cancer who developed rapidly progressive ISCM at the T11\\u0026ndash;T12 level, accompanied by acute neurological dysfunction. We retrospectively analyzed her clinical manifestations, imaging features, pathological characteristics, surgical treatment, and prognosis. Combined with a review of the relevant literature, we aim to improve the understanding of early diagnosis and individualized treatment of this rare disease.\\u003c/p\\u003e\"},{\"header\":\"Case presentation\",\"content\":\"\\u003cp\\u003eThe patient was a 67-year-old female. She underwent surgery for a left breast mass approximately 3.5 years ago. Postoperative pathology revealed invasive ductal carcinoma of the breast (histological grade III, 3 + 3+2). Immunohistochemistry: ER(-), PR(-), Her-2(0). Based on the pathology, she received 4 cycles of EC-T regimen chemotherapy 20 days after surgery and was discharged smoothly, with regular follow‑up thereafter. Two years later, chest CT showed progressive enlargement of multiple nodules in the right lower lobe, accompanied by lymphadenopathy in the right hilum and anterior mediastinum. Percutaneous needle biopsy confirmed pulmonary metastasis of breast cancer (poorly differentiated). Immunohistochemistry: ER(-), PR(-), HER-2(1+), GATA-3(+), CK7(+), P120(membrane+), TIF-1(-), NapsinA(-), Ki-67 (positive rate approximately 70%). She then received scheduled chemotherapy regimens: docetaxel + carboplatin, followed by nab-paclitaxel + camrelizumab (immunochemotherapy). Over the past year, the patient gradually developed numbness of hands and feet, paroxysmal headache and distension, and lower extremity weakness. Brain MRI suggested possible brain metastasis from breast cancer, and she underwent radiotherapy with a smooth course. Follow-up brain MRI showed the lesions were smaller and fewer than before. Subsequently, she received targeted chemotherapy with bevacizumab + gemcitabine + cisplatin.\\u003c/p\\u003e \\u003cp\\u003eRecently, the patient complained of low back pain with obvious sensory and motor disturbances in both lower extremities. Thoracolumbar MRI revealed an intramedullary space‑occupying lesion at the T11–T12 vertebral level. Physical examination showed: Muscle strength of both lower extremities: approximately grade III. Slightly decreased muscle tone. Diminished superficial and deep sensation, more obvious on the left side. Three days later, the patient’s sensory and motor functions of both lower extremities deteriorated rapidly. Examination revealed flaccid paralysis of both lower extremities with muscle strength grade 0. The sensory level was approximately at T11 on the left and L1 on the right. An emergency operation was performed to resect the intramedullary spinal cord mass. Postoperative pathology and immunohistochemistry confirmed intramedullary metastasis of breast cancer. Immunohistochemistry: CK5/6(focal +), CK7(+), GATA-3(+), GFAP(-), Oligo-2(-), P40(-), TRPS1(+), Villin(-). Postoperatively, the patient was treated with methylprednisolone sodium succinate 80 mg as a pulse therapy.\\u003c/p\\u003e \\u003cp\\u003eWithin 24 hours, the sensory level gradually descended and finally stabilized at the L3 level, but no significant recovery of muscle strength or tone was observed.\\u003c/p\\u003e\"},{\"header\":\"Discussion and Review of Literature\",\"content\":\"\\u003cp\\u003eISCM represents an extremely rare and devastating complication of systemic malignancies, among which breast cancer is one of the most common primary tumors responsible for ISCM[\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Owing to its low incidence, atypical clinical manifestations and rapid neurological progression, ISCM is prone to delayed diagnosis or misdiagnosis in clinical practice, which frequently results in severe neurological dysfunction and an extremely dismal prognosis. In the present study, we reported a 67-year-old female patient with triple‑negative breast cancer who developed rapidly progressive ISCM at the T11‑T12 level accompanied by acute flaccid paralysis of bilateral lower extremities. Combined with a systematic literature review over the past decade, we analyzed the clinical characteristics, treatment modalities and prognostic factors of breast cancer‑associated ISCM, aiming to provide evidence for early diagnosis and individualized comprehensive management.\\u003c/p\\u003e\\u003cp\\u003eWe retrieved a total of 201 articles published in the past decade using the search strategy: (Breast Cancer) AND (((Metastasis) AND ((Intramedullary) OR (Spinal Cord))) OR (intramedullary spinal cord metastases)). A total of 22 articles were initially screened by reviewing the titles and abstracts, and their full texts were retrieved. Among them, 3 articles were unavailable. After carefully reading the remaining 19 full-text articles, 12 studies involving 14 patients were finally included in this literature review.\\u003c/p\\u003e\\u003cp\\u003eTable I. Studies included in systematic review\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003ctable id=\\\"Taba\\\" border=\\\"1\\\"\\u003e \\u003ccolgroup cols=\\\"15\\\"\\u003e \\u003c/colgroup\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003eSurvival\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003e1month\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003e1.5month\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003e3month\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003e4month\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\"\\u003e \\u003cp\\u003e3month\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eOutcome\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDead\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDead\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDead\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDeteriorated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDeteriorated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDeteriorated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDead\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDead\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eType of Treatment\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、chemotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、Steroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、chemotherapy 、\\u003c/p\\u003e \\u003cp\\u003eSteroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSteroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、Steroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、Trastuzumab\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery、RT 、Steroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery、Steroid hormone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRT 、chemotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eInterval from Primary tumor to ISCM diagnosis\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003ediagnosis\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e24month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e24month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e72month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eInitial symptom\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eInitial symptom\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e24month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e264month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e60month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e32month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e133month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e17month\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e3month\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eMetastases to other organs\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eBone 、Liver、 Lung、 Brain、 Axillary lymph nodes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eBrachial plexus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eLiver\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT7−10 vertebral body\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eLocal recurrence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eBrain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eBone、 Liver、 Brain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eBrain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRib、 Brain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLocalization\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT11-T12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC6-T2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC6-C7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT11-T12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC2-C3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT7-T8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eConus medullaris and Cauda equina\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC7 T12 L1 L4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC2 T3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eT11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eC6-C7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSex\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eF\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e66\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e38\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNo. of patients\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCountry\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eTunisia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eUK\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eTunisia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eTurkey\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eJapan\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eFrance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eJapan\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eMorocco\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eYear\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2025\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e \\u003cp\\u003e2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFirst Author\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eWala Ben Kridis[\\u003cspan class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDario Aiello[\\u003cspan class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eN Jayakumar[\\u003cspan class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eNadia Bouattour[\\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCoskun Ozturker[\\u003cspan class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eTerufumi Kawamoto[\\u003cspan class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCharles E Mackel[\\u003cspan class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eMarion Tonneau[\\u003cspan class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eEric Feldstein[\\u003cspan class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eHiroaki Yamane[\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e \\u003cp\\u003eBen A Strickland[\\u003cspan class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eM Hommadi[\\u003cspan class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eStudy design\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eRetrospective study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e \\u003cp\\u003eRetrospective study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCase report\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNo\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003eAll 14 patients were female, with an age range of 30–70 years (mean 49.786 ± 11.676 years), indicating that middle-aged and elderly women are the main affected population. Geographically, the reported cases were distributed across multiple countries, with the United States accounting for the largest proportion(35.71%), followed by Japan༈14.29%༉ and Tunisia༈14.29%༉. Among the included studies, case reports accounted for the majority༈71.43%༉, while retrospective studies were relatively few༈35.71%༉, which further confirmed the rarity and sporadic characteristics of this disease.\\u003c/p\\u003e\\u003cp\\u003eRegarding lesion distribution, most patients presented with a single intramedullary lesion involving multiple segments(85.71%), and only 2 patients had multiple metastatic lesions༈14.29%༉, with the highest number of involved segments reaching four. The cervical spinal cord was the most common site༈46.43%༉, followed by the thoracic segment༈42.86%༉, which was slightly different from the distribution characteristics of ISCM reported in previous studies[22.23]. In our case, the lesion was located at the T11-T12 thoracic spinal cord, which is a common predilection site. In addition, most patients had other systemic metastases༈64.29%༉, including 5 cases with central nervous system metastases (35.71%), suggesting that breast cancer patients with a history of intracranial metastasis should be alert to the possibility of concurrent spinal cord metastasis.\\u003c/p\\u003e\\u003cp\\u003eThe time interval from the diagnosis of primary breast cancer to the occurrence of ISCM varied greatly, ranging from 3 to 144 months (mean 53.300 ± 49.273 months), and a small number of patients(14.29%) initially presented with ISCM as the first clinical manifestation. This suggests that ISCM can occur at any stage of breast cancer, and clinicians should maintain long-term follow-up and vigilance even in patients with stable conditions. In terms of treatment, there is still no unified standard guideline. Monotherapy༈42.86%༉ and combined therapy༈57.14%༉ were used in clinical practice, among which surgical resection༈42.86%༉and radiotherapy༈57.14%༉ were the most common local treatments.In addition, 42.86% of the patients received steroid therapy. No statistically significant difference in patient prognosis was observed between the different treatment modalities. This finding may be partly explained by the relatively small number of cases enrolled in the present study. In our patient, emergency surgical resection was performed due to rapid neurological deterioration, supplemented with steroid therapy postoperatively. Partial relief of neurological symptoms was achieved after surgery, indicating that timely surgical decompression may help to rescue residual neurological function.\\u003c/p\\u003e\\u003cp\\u003eTable II. The relationship between different therapeutic regimens and prognosis.\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003c/div\\u003e\\u003ctable id=\\\"Tabb\\\" border=\\\"1\\\"\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003c/colgroup\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eMonotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eCombined Therapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eX²\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eP\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eImproved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.250\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e0.682\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003eDeteriorated / Dead\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003eThe overall prognosis of patients with breast cancer-related ISCM was unsatisfactory. Half of the patients had poor outcomes, including death (35.71%) or aggravated neurological symptoms(14.29%), and the median survival time of deceased patients was only 2.5 months. This reflects the highly aggressive nature of ISCM and the limited efficacy of current treatments. Early imaging screening, precise pathological diagnosis and multidisciplinary comprehensive treatment may help to improve the clinical outcomes of such patients.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn summary, ISCM from breast cancer is an extremely rare, rapidly progressive, and devastating complication with an extremely poor prognosis. Based on our case report and literature review of 14 patients in the past decade, this entity predominantly affects middle-aged and elderly female patients, with single lesions most commonly seen in the cervical and thoracic spinal cord. A considerable proportion of patients have a history of other systemic metastases, often accompanied by involvement of the central nervous system. At present, there is no standardized treatment guideline, and surgical resection, radiotherapy, and combined comprehensive therapy are the main therapeutic strategies. Early recognition based on clinical manifestations and MRI findings, as well as timely multidisciplinary intervention, may help alleviate neurological deterioration. However, the overall survival remains dismal for most patients. Further accumulation of clinical cases and high-quality studies are warranted to establish optimal diagnosis and treatment protocols for this rare condition.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis case report does not constitute human subject research requiring ethics approval. However, the study adhered to the ethical principles outlined in the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for Publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor- in-Chief of this journal.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eZhongqiang Hu: case collection and organization, analysis of imaging data and Pathological sections, article writing and revision;\\u003c/p\\u003e\\n\\u003cp\\u003eHuiyan Wang: case organization, feasibility analysis of article writing, paper review and proofreading.\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Guidelines\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRelevant guidelines and regulations were in effect for all methods.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36cancers in 185 countries[J]. CA Cancer J Clin 74(3):229\\u0026ndash;263\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThe Society of Breast Cancer China Anti-Cancer Association Guidelines for breast cancer diagnosis and treatment by China AntiCancer Association(2026 edition)[J]. China Oncology,2025,35(12): 1157\\u0026ndash;1254\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWilliam J, Gradishar MS, Moran J, Abraham et al (2024) Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw 22(5):331\\u0026ndash;357\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZhang Y, Asad S, Weber Z et al (2021) Genomic features of rapid versus late relapse in triple negative breast cancer[J]. BMC Cancer 21(1):568\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLv J, Liu B, Quan X et al Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review[J]. Onco Targets Therapy 2019 Jun 21:12:4741\\u0026ndash;4753\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePhong Dam-Hieu, Seizeur R, Mineo J-F et al (2009) Retrospective study of 19 patients with intramedullary spinal cord metastasis[J]. Clin Neurol Neurosurg 111(1):10\\u0026ndash;17\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLee SS, Kim MK, Sym SJ et al (2007) Intramedullary spinal cord metastases: a single-institution experience[J]. J Neurooncol 84(1):85\\u0026ndash;89\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTakeshi Nishimura H, Yamazaki G, Suzuki et al (2022) Palliative Radiation Therapy for Intramedullary Spinal Cord Metastasis[J]. Cancer Diagn Progn 2(6):702\\u0026ndash;706\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJayakumar N, Ismail H, Athar S et al (2020) Perineural invasion in intramedullary spinal cord metastasis[J]. Ann R Coll Surg Engl 102(5):e94\\u0026ndash;e96\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDario Aiello R, Mazzola F, Gregucci et al (2017) Surprising complete response of intramedullary spinal cord metastasis from breast cancer: a case report and literature review[J].Tumori. 103(Suppl 1):e28\\u0026ndash;e30\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKridis WB, Nefzi I, Souissi B et al (2024 May) Intramedullary spinal cord metastasis from breast cancer: an ambiguous entity[J]. BMJ Support Palliat Care 2:spcare\\u0026ndash;2024\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTerufumi Kawamoto T, Yamashita S, Kaito et al (2016) Intramedullary Spinal Cord Metastasis from Breast Cancer Mimicking Delayed Radiation Myelopathy: Detection With (18)F-FDG PET/CT[J]. Nucl Med Mol Imaging 50(2):169\\u0026ndash;170\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTakeshi Nishimura H, Yamazaki G, Suzuki et al (2022) Palliative Radiation Therapy for Intramedullary Spinal Cord Metastasis[J]. Cancer Diagn Progn 2(6):702\\u0026ndash;706\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNadia Bouattour S, Sellami Y, Mzid et al (2025) Intramedullary spinal cord metastasis presenting as the initial manifestation of breast cancer: case report and review of the literature[J]. Spinal Cord Ser Cases 11(1):13\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCoskun Ozturker AK, Sivrioglu HO, Sildiroglu et al (2016) Breast cancer presenting with intramedullary cervical spinal cord metastasis[J]. Spine J 16(7):e463\\u0026ndash;e464\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCharles E, Mackel G, Alsideiri EP (2020) Intramedullary-Extramedullary Breast Metastasis to the Caudal Neuraxis Two Decades after Primary Diagnosis: Case Report and Review of the Literature[J]. World Neurosurg Aug:140:26\\u0026ndash;31\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTonneau M, Rapha\\u0026euml;lle, Mouttet-Audouard F, Le Tinier et al (2021) Stereotactic body radiotherapy for intramedullary metastases: a retrospective series at the Oscar Lambret center and a systematic review[J]. BMC Cancer. ;21(1):1168\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFeldstein E, Li B, Kim M et al (2022 Jun) Resection of Thoracic Intramedullary Breast Metastasis Through the Dorsal Root Entry Zone: 2-Dimensional Operative Video[DB/OL]. World Neurosurg 162:9\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHiroaki Yamane T, Itagaki K, Kajitani (2024) Trastuzumab Deruxtecan for HER2-Positive Breast Cancer with Central Nervous System Metastasis[J]. Case Rep Oncol 18(1):22\\u0026ndash;28\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBen A, Strickland IE, McCutcheon I, Chakrabarti et al (2018) The surgical treatment of metastatic spine tumors within the intramedullary compartment[J]. J Neurosurg Spine 28(1):79\\u0026ndash;87\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHommadi M, Belemlih M, Marnouch E et al (2021) Intramedullary spinal cord metastases: Report of three cases and review of the literature[J]. Cancer Radiother 25(2):169\\u0026ndash;174\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMotoyuki Iwasaki K, Naito T, Endo et al (2023) Impact of surgical treatment for intramedullary spinal cord metastasis on neurological function and survival: A multicenter retrospective study by the Neurospinal Society of Japan[J]. J Clin Neurosci Nov:117:27\\u0026ndash;31\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSalvotti HV, Lein A, Proescholdt M et al (2024) Characteristics and Outcome of Surgically Treated Patients with Intradural Extra- and Intramedullary Spinal Metastasis-A Single-Center Retrospective Case Series and Review[J]. Curr Oncol 31(7):4079\\u0026ndash;4092\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Breast cancer, Intramedullary spinal cord metastasis, Metastatic tumor, Surgical treatment\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9064543/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9064543/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground: \\u003c/strong\\u003eBreast cancer is one of the most common malignant tumors in women. Distant metastases are most frequently seen in the lung and bone, whereas intramedullary spinal cord metastasis ( ISCM ) is extremely rare. Herein, we report a rare case of ISCM from breast cancer.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCase presentation：\\u003c/strong\\u003eA 67-year-old female was diagnosed with breast cancer 3.5 years ago and received standardized systemic treatment. Unfortunately, 2 years later, she developed lung and brain metastases. Recently, she was diagnosed with ISCM due to sensory and motor dysfunction of both lower extremities, and underwent surgical treatment. Within 24 hours postoperatively, her sensory level gradually decreased and finally stabilized at the L3 level, but no significant recovery in muscle strength or tone was observed.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eISCM from breast cancer is an extremely rare, rapidly progressive, and devastating complication with an extremely poor prognosis. The overall survival remains dismal for most patients. Further accumulation of clinical cases and high-quality studies are warranted to establish optimal diagnosis and treatment protocols for this rare condition.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Rapidly progressive Intramedullary Spinal Cord Metastases from Breast Cancer: a case report and review of the literature\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-10 16:48:00\",\"doi\":\"10.21203/rs.3.rs-9064543/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fb873ec4-aafe-4bea-867a-f0cec3719f8b\",\"owner\":[],\"postedDate\":\"March 10th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":64123866,\"name\":\"Neurology\"}],\"tags\":[],\"updatedAt\":\"2026-03-10T16:48:00+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-10 16:48:00\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9064543\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9064543\",\"identity\":\"rs-9064543\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}