Rare Metastatic Adenocarcinoma to the Spine Infiltrating Three Adjacent Foramen in Lumbar Vertebrae

: An 83-year-old man presented with severe back pain and worsening neurodeficit. Lateral radiographs showed the presence of compression fractures of the L1 to L2 vertebral bodies. Computed tomography (CT) scan showed an intravertebral vacuum sign suggestive of ischemic fracture. Magnetic resonance imaging showed a large right retroperitoneal mass infiltrating the vertebral bodies and entering the spinal canal from L1 to L4 neural foramina. A fluid sign usually suggestive of acute compression fractures was seen near the superior end plate of the L1 vertebral body in our patient. Computed tomography-guided biopsy confirmed the diagnosis of metastatic adenocarcinoma. However, the primary site could not be found despite several investigations. It is usually thought that the primary tumor spreads to the spine through the valveless Batson's plexus or by direct arterial seeding into vertebral bodies. A paravertebral primary tumor such as a lymphoma, a primary tumor from the lungs, or a renal cell carcinoma can potentially infiltrate the vertebral bodies and enter the spinal canal through the neural foramen. But a large retroperitoneal metastatic mass from an unknown primary adenocarcinoma is a rare condition. No reports exist in the literature on a metastatic mass infiltrating vertebral bodies and then entering the epidural space through the 3 consecutive neural foramen. Thus, the pathogenesis of metastatic adenocarcinomas, particularly when the primary site is unknown, is not completely understood and can give a varied radiological presentation.