INTRAMEDULLARY SPINAL CORD METASTASIS AS THE PRESENTING FEATURE OF PAPILLARY THYROID CARCINOMA.
Journal
AACE clinical case reports
ISSN: 2376-0605
Titre abrégé: AACE Clin Case Rep
Pays: United States
ID NLM: 101670593
Informations de publication
Date de publication:
Historique:
received:
06
02
2019
accepted:
06
05
2019
entrez:
23
1
2020
pubmed:
23
1
2020
medline:
23
1
2020
Statut:
epublish
Résumé
The objective of this report is to present an unusual case of intramedullary spinal cord metastasis (ISCM) as the presenting feature of papillary thyroid carcinoma (PTC). The presented case includes clinical, biochemical, and imaging findings as well as surgical and pathology reports. Treatment with radioactive iodine (RAI) and the response to this treatment are presented. A 71-year-old woman was evaluated for debilitating low back pain and walking disability. Magnetic resonance imaging demonstrated an oval, lumbar, intramedullary mass with benign features and surgery was scheduled. On preoperative evaluation for the lumbar mass, a multinodular thyroid goiter (unfortunately overlooked previously) was noticed, causing severe narrowing of the trachea. Total thyroidectomy was performed with a pathology diagnosis of PTC. In a second operation, the lumbar lesion was removed and proved to represent metastatic PTC. External beam radiation was subsequently administered to the thyroid bed, lumbar spine, and other skeletal metastases, followed by 150 milliCurie of RAI. A post-treatment scan showed high uptake over the lumbar spine, and skeletal and lung lesions. Clinically, the patient restored her walking ability and back pain improved. ISCM rarely is the presenting feature of PTC. Our patient presented with back pain which is the typical, though non-specific symptom, of ISCM. She showed good clinical response to multimodal treatment which is in line with the few other differentiated thyroid cancer patients with ISCM reported in the literature. Prompt surgical resection, followed by external beam radiation and RAI, may improve neurological signs, alleviate pain, and improve quality of life.
Identifiants
pubmed: 31967051
doi: 10.4158/ACCR-2019-0072
pmc: PMC6876958
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e271-e275Informations de copyright
Copyright © 2019 AACE.
Déclaration de conflit d'intérêts
DISCLOSURE The authors have no multiplicity of interest to disclose.
Références
Crit Rev Oncol Hematol. 2018 May;125:111-120
pubmed: 29650270
Cureus. 2016 Apr 27;8(4):e590
pubmed: 27284497
Thyroid. 2011 Nov;21(11):1269-71
pubmed: 21936676
Arch Neurol. 1987 May;44(5):526-31
pubmed: 3579664
Clin Neurol Neurosurg. 2012 Sep;114(7):1107-9
pubmed: 22296651
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
Thyroid. 2014 Feb;24(2):270-6
pubmed: 23734630
Cancer. 2003 Jul 15;98(2):356-62
pubmed: 12872357
Cancer. 2007 Oct 1;110(7):1451-6
pubmed: 17705176
J Korean Neurosurg Soc. 2012 Apr;51(4):230-2
pubmed: 22737305
J Clin Endocrinol Metab. 1995 Jul;80(7):2041-5
pubmed: 7608252
Neurol Med Chir (Tokyo). 1996 Aug;36(8):593-7
pubmed: 8831205
Acta Neurochir (Wien). 2004 Dec;146(12):1347-54; discussion 1354
pubmed: 15526223
J Clin Neurosci. 2018 Mar;49:7-15
pubmed: 29248379
J Clin Endocrinol Metab. 1997 Nov;82(11):3637-42
pubmed: 9360519
Surg Neurol Int. 2016 May 17;7(Suppl 13):S375-9
pubmed: 27274413
Arq Neuropsiquiatr. 2006 Jun;64(2A):338-41
pubmed: 16791383
J Clin Endocrinol Metab. 2013 Jan;98(1):172-80
pubmed: 23150687