Surgical management of follicular carcinoma of thyroid with spinal metastasis

Abstract

INTRODUCTIONDifferentiated thyroid cancer (DTC) account for the vast majority (90%) of all thyroid cancers and includes papillary (70-75%) and follicular (15-20%) cancers. 1,2 Follicular carcinoma of thyroid is a slow growing tumour with peak incidence in fifth decade and three times more common in females.3 Differentiated thyroid cancer metastasis to the lung (49%) followed by bone (25%). Bone metastasis is commonly seen in follicular carcinoma (7-28%) than in papillary carcinoma (1-7%). 4,5 Spine is the most common part of bone metastasis of follicular carcinoma and is primarily osteolytic. The primary concern with metastasis is pathologic fracture and/or spinal cord compression, which may lead to intractable pain, sensory alterations, weakness, and/or paralysis.6,7 Management is curative or palliative and includes surgery, radioiodine ablation, selective embolization, and medical management. 8,9 In this study, we present a retrospective analysis of five patients with follicular carcinoma of thyroid with spinal metastasis treated surgically. ABSTRACTBackground: Spine is the most common part of bone metastasis of follicular carcinoma and is primarily osteolytic. The primary concern with metastasis is pathologic fracture and/or spinal cord compression, which may lead to intractable pain, sensory alterations, weakness, and/or paralysis. Management is curative or palliative and includes surgery, radioiodine ablation, selective embolization, medical management. In this study, we present a retrospective analysis of five patients with follicular carcinoma of thyroid with spinal metastasis treated surgically. Methods: With the approval of the institutional review board, we retrospectively analyzed all the patients who underwent surgery for follicular carcinoma of thyroid with spinal metastasis from Jan 2011 to Jan 2015 at Sri Ramachandra Medical Centre. Patients were considered for spine surgery, when they had severe pain and/or neurological deficit, spinal instability and Tokuhashi score of at least 9. Total of 5 patients with follicular carcinoma underwent spinal surgery. Results: Three patients had improvement in KPS scores; one had no change and remaining one had lower KPS score at final follow up. Four out of the five patients (80%) had improvement in VAS pain scores. Conclusions: Even though there are no established regimens in treating spinal metastasis from follicular carcinoma of thyroid and very few reports published in this regard, curative/palliative spine surgery along with radioiodine ablation gives short to midterm remission and clinical improvement in this patient group.

Spinal Metastasis as Presenting Feature of Follicular Type Thyroid Carcinoma: A Case Report and Review of the Literature

“…This characteristic is probably due to that FTC usually spreads via blood, however, papillary type prefers lymphatic route for dissemination (2). There is bone involvement in 7-12% of the cases with FTC (3), and the most frequently involved region is spinal column (4). However, most of the spinal metastases occur in the late stage of the disease, and presentation of the disease with spinal metastasis is extremely rare during initial diagnosis.…”