P54-5 Metastatic spinal cord compression caused by recurrent carcinoma ex pleomorphic adenoma of the parotid gland

Abstract

Introduction: Metastatic spinal cord compression (MSCC) is one of the serious sequelae of malignancy. Due to its rapid progression of neurological dysfunction, it is considered an oncologic emergency that demands prompt diagnosis and management. Most cases of MSCC occur from breast, lung, and prostate primaries. MSCC secondary to carcinoma ex pleomorphic adenoma of the parotid gland is rare. Case presentation: We report a 32-year-old Filipino ex-smoker male complaining of two-week history of progressive paresis associated with urinary and bowel retention. He had a history of total unilateral neck dissection for CEPA of the parotid gland last year followed by systemic chemotherapy with CAP regimen (cyclophosphamide 500 mg/m2, doxorubicin 50 mg/m2, cisplatin 50 mg/m2) for four cycles. Due to COVID-19 pandemic, he lost to follow-up. On examination, physical examination revealed an 8 x 8 cm recurrent fungating mass at the right post-auricular area with extension to the buccal cavity. Motor strength was 0/5 for both lower extremities with associated hyporeflexia. Sensation to pain, temperature, and proprioception was noted to be absent at the level of the umbilicus and below. Contrast-enhanced chest and abdominopelvic CT scan revealed mixed lytic-sclerotic osseous foci at the thoracic and lumbar vertebral bodies, multiple intramuscular soft tissue foci, as well as bilateral lung and pleural-based nodules. Whole body bone scan showed multiple bone metastases. Radiation therapy to the spine was given at a total of 30 cGy in 10 fractions. Intravenous dexamethasone and bone resorption therapy were given. Palliative chemotherapy (paclitaxel 200 mg/m2, carboplatin AUC 6 mg·min/mL) was subsequently started. Conclusion: Although relatively rare, MSCC should be taken into consideration when a patient with history of CEPA presents with paraplegia. Prompt diagnosis and management are particularly important in preventing permanent neurological damage.