Chemotherapy-Refractory Esophageal Squamous Cell Carcinoma with Concurrent Long-Segment Intramedullary Spinal Metastases and Brain Metastases:Case Reports and Literature Review

Background Intramedullary spinal metastases (ISCM) are an extremely rare complication of systemic malignant tumors affecting the central nervous system, with a very poor prognosis,Among these, esophageal squamous cell carcinoma (ESCC) is particularly rare as a primary tumor.To date, there have been only seven documented cases of ISCM associated with esophageal cancer,In all cases, involvement was limited to a single segment of the spinal cord.This article reports the first case of esophageal squamous cell carcinoma (ESCC) with long-segment intramedullary metastasis in the thoracic segment during chemotherapy, complicated by concurrent brain metastases. Case Presentation A 69-year-old male patient with advanced ESCC (cT4N1M1, with liver metastases),After receiving three cycles of albumin-bound paclitaxel combined with cisplatin chemotherapy,The patient presented with acute pain in the left shoulder and right lower limb, weakness in the right lower limb (Grade IV on the Medical Research Council muscle strength scale), and decreased sensation in the abdomen.Gadolinium-enhanced magnetic resonance imaging (MRI) of the spinal cord revealed extensive intramedullary lesions spanning long segments from T1 to T12,Accompanied by characteristic ring-shaped enhancement,accompanied by characteristic ring-shaped enhancement,at the same time, edema of the cervical spinal cord is visible, but there is no enhancement.A concurrent cranial MRI revealed one new annular enhancing nodule in the left frontal lobe and one in the right cerebellum.Given the widespread involvement of the central nervous system and the family’s refusal of surgery and radiation therapy, the patient died 15 days after discharge. Conclusion Even in patients in whom systemic chemotherapy appears to be effective, ISCM can still occur, possibly due to tumor cells crossing the blood-spinal cord barrier via the hematogenous route.Gadolinium-enhanced MRI and annular enhancement are key to the diagnosis.This case highlights that when acute neurological symptoms occur during cancer treatment, the threshold for ordering neuroimaging should be lowered,this allows for early detection, thereby giving some patients the opportunity to undergo palliative radiation therapy or surgery.