Intramedullary spinal cord metastasis from thyroid carcinoma: Case report and a systematic pooled analysis of the literature

O'Neill, Anthea H.; Phung, Teik Beng; Lai, Leon T.

doi:10.1016/j.jocn.2017.12.001

Cited by 12 publications

(17 citation statements)

References 114 publications

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“…ISCM is a rare complication of cancer in general and an extremely rare metastatic site of DTC (1-3). A comprehensive search of the English literature revealed several cases of ISCM from DTC, 8 of which are presented with the current case in Table 1 (2,3,(10)(11)(12)(13)(14)(15). Patient age ranged between 31 and 76 years, 5 of 9 were females.…”

Section: Discussionmentioning

confidence: 99%

“…ISCMs associated with DTCs are extremely rare. Only a few cases have been reported, and most were patients with preexisting, usually metastatic, PTCs (2,3,(10)(11)(12)(13)(14)(15). Here we report a patient with ISCM, radiographically mimicking an ependymoma (a benign, primary CNS neoplasm), as the presenting feature of PTC as well as a literature review of this rare entity.…”

Section: Introductionmentioning

confidence: 94%

“…The most common primary malignancies leading to ISCM were lung, breast, melanoma, and renal cell carcinoma. Typical signs and symptoms were weakness, sensory changes, bowel or bladder dysfunction, and radicular pain (3).…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary Spinal Cord Metastasis as the Presenting Feature of Papillary Thyroid Carcinoma

Yoel

Joshua

Shoukrun

et al. 2019

AACE Clinical Case Reports

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Objective: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).Methods: 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.Results: 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 meta-static 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.Conclusion: 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. (AACE Clinical Case Rep. 2019;5:e271-e275) Abbreviations: CNS = central nervous system; DTC = differentiated thyroid carcinoma; FTC = follicular thyroid carcinoma; ISCM = intramedullary spinal cord metastasis; PTC = papillary thyroid carcinoma; RAI = radioactive iodine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

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Intramedullary Spinal Cord Metastasis as the Presenting Feature of Papillary Thyroid Carcinoma

Yoel

Joshua

Shoukrun

et al. 2019

AACE Clinical Case Reports

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“…Among them, ISCM from lung cancer (ISCM-LC) were estimated to be the predominant type, accounting for 42.4-67.21% [2][3][4] . As cancer patients survived longer over decades, the incidence of ISCM has reportedly increased 5 .…”

Section: Introductionmentioning

confidence: 99%

Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review

Wang

Yang

et al. 2022

Neurospine

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Objective: Intramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis. Methods:We reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis and multivariate Cox regression analysis were performed to comprehensively study the disease.Results: All six patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, one died of pulmonary embolism, one was alive, and two were lost to followup. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly.Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20% and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found gender, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms and gender were three independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months. Conclusion:The overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.

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“…Nevertheless, only less than 0.5% of cancer patients will be clinically affected by intramedullary metastases and only 0.6% of all spinal cord tumors are secondary due to metastatic disease [6][7][8]. Cases of metastatic intramedullary spread have been reported for a variety of cancer entities including lung, breast, renal cell, colorectal, ovarian and prostate cancer, as well as melanoma, but also rarer ones such as carcinoid tumors or thyroid cancer [6,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases—A Multicenter Experience

Ehret

Senger

Kufeld³

et al. 2021

Cancers

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Background: Intramedullary metastases are rare and bear a dismal prognosis. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for patients with resectable and localized metastatic spread, previous case reports and case series suggest radiosurgery to be another viable treatment modality. This multicenter study analyzes the efficacy and safety of robotic radiosurgery (RRS) for intramedullary metastases. Methods: Patients who received RRS for the treatment of at least one intramedullary metastasis were included. Results: Thirty-three patients with 46 intramedullary metastases were treated with a median dose of 16 Gy prescribed to a median isodose of 70%. The local control was 79% after a median follow-up of 8.5 months. The median overall survival (OS) was 11.7 months, with a 12- and 24-month OS of 47 and 31%. The 12-month progression-free survival was 42% and at 24 months 25%. In addition, 57% of patients showed either an improved or stable neurological function after treatment delivery. Systemic disease progression was the main cause of death. No significant treatment-related toxicities were observed. Conclusions: RRS appears to be a safe, time-saving and effective treatment modality for intramedullary metastases, especially for patients with unresectable lesions and high burden of disease.

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Intramedullary spinal cord metastasis from thyroid carcinoma: Case report and a systematic pooled analysis of the literature

Cited by 12 publications

References 114 publications

Intramedullary Spinal Cord Metastasis as the Presenting Feature of Papillary Thyroid Carcinoma

Intramedullary Spinal Cord Metastasis as the Presenting Feature of Papillary Thyroid Carcinoma

Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review

Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases—A Multicenter Experience

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