EP211 An unusual case of intramedullary spinal cord metastasis from breast cancer

Introduction/Background Breast cancer (BC), depending on molecular subtype, usually metastasize to the liver, lungs, bone and brain. We report an interesting case of a patient, previously treated for hormone receptor-positive, HER2-negative early BC, who presented 7 years later with HER2-positive metastatic disease. Finally she developed an intramedullary spinal metastasis. Methodology A 61 year-old woman underwent left mastectomy in 2010 for BC hormone receptor-positive, HER2-negative, with lymph node involvement. She also received adjuvant chemotherapy, radiation therapy and hormonal treatment until 2017. In 2017 she received Paclitaxel/Bevacizumab followed by Bevacizumab maintenance for recurrence in the lungs, liver and bones. In February 2018 she underwent rebiopsy in the liver due to progressive disease, which revealed metastasis from hormone receptor-negative, HER2-positive BC. She received Trastuzumab/Pertuzumab/Docetaxel until August 2018. In the meanwhile she receive whole-brain radiation therapy in June 2018 for multiple brain metastases. In August 2018 she started Trastuzumab-Emtansine due to progressive disease. On January 2019 she presented in our department with paraplegia. Results Spine MRI was performed ad revealed an intramedullary lesion on level T12-L1 of 3.6×1.5×1.4 cm with contrast enhancement. Differential diagnosis included metastasis from breast cancer and ependymoma. Blood tests indicated thrombopenia and hepatic disturbances. After discussion with the neurosurgeons and radiation oncologists we did not offer any treatment to our patient, because of the established paralysis of the lower extremities. Conclusion BC can rarely give intramedullary spinal lesions. Their treatment is quite challenging. Disclosure Nothing to disclose.