1142 - The Rehabilitation Course of Metastatic Clear Cell Carcinoma with Unknown Primary Source

A patient presented with progressive back pain, bilateral lower extremity weakness, and nausea. Imaging revealed metastatic disease with spinal cord compression, osseous metastases, a hemorrhagic cerebellar mass, and pulmonary nodules. She underwent thoracic decompression kyphoplasty, followed by inpatient rehabilitation, where she demonstrated functional gains. Later, she required a left retro-sigmoid craniotomy for tumor resection and returned to rehabilitation.

On admission, she exhibited profound deficits in strength, balance, mobility, and activities of daily living. With therapy, she progressed to ambulating 80 feet with an Arjo walker and assistance from 2–3 therapists while regaining independence in eating, oral hygiene, and upper extremity dressing. Following her second neurosurgical intervention, however, she developed worsening leg weakness and cognitive decline, leading to loss of independence in transfers and activities of daily living, including showering and dressing. Despite multidisciplinary efforts, her condition deteriorated, and she passed before initiation of chemotherapy.

Discussions:

This rare and complex case highlights the critical intersection of oncology, neurosurgery, and rehabilitation. Even in the context of aggressive malignancy and uncertain prognosis, rehabilitation played a pivotal role in preserving mobility, mitigating symptoms, and enhancing quality of life. The patient’s dynamic functional trajectory underscores the necessity of continuous reassessment and adaptation of rehabilitative strategies in progressive neurological disease. Furthermore, this case illustrates the value of multidisciplinary collaboration, with rehabilitation serving not only as a bridge between surgical and oncologic care but also as a cornerstone of patient-centered management.

Conclusions: Managing metastatic disease with neurological involvement requires multidisciplinary care. Rehabilitation is essential for preserving function, mobility, and quality of life, even as disease progresses. This case highlights rehabilitation’s role in supporting functional gains, aligning care with patient goals, and promoting dignity. Rehabilitation should be recognized as a critical component of cancer care, offering value even without curative options.