Isolated Spinal Metastasis with Spinal Cord Compression Leads to a Diagnosis of a Follicular Thyroid Carcinoma

Abstract

Introduction: Thyroid carcinoma initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases. Spinal cord compression from an epidural metastatic lesion as a first symptom is extremely rare. One would expect such a presentation to occur much later in the course of the disease.Methods: We are presenting a case report of a follicular thyroid carcinoma that presented with spinal cord compression from a thoracic epidural metastatic lesion in a previously healthy 55-year-old male. A single metastasis of follicular thyroid carcinoma presenting with posterior spinal cord compression is rare. In this particular case, our management included a mid-thoracic laminectomy, followed by resection of the epidural lesion. Once the surgical pathology confirmed the diagnosis of a follicular thyroid carcinoma, the general surgery team performed a near total thyroidectomy, after which he received radioactive iodine therapy. The patient is symptom-free at his three-year follow-up.Conclusion: Initial presentation of follicular thyroid carcinoma with symptomatic thoracic myelopathy from an epidural metastasis is very uncommon. An early diagnosis and prompt surgical intervention provided an excellent outcome.

An occult Follicular Thyroid Carcinoma revealed by an Isolated Caudaequina syndrome: a Rare Presentation

“…Thyroid cancer is a rare entity that accounts for roughly 1% of all new malignant disease with a male to female ratio of 1:3 [1] broadly divided into two categories. Differentiated thyroid cancer (DTC) accounts for most malignancies 90% of all thyroid cancers.…”

“…Early diagnosis with a thorough assessment of thyroid gland when a spinal metastasis is suspected and prompt management of the primary carcinoma and the metastatic lesion, sustainable maintenance of thyroid suppression, and consideration of the patient's age, response to therapies, and comorbidities, may extend long-term survival and allow a favorable prognosis. Thyroidectomy with radioactive iodine ablation increases the 10-year survival in patients with metastatic disease [1].…”

“…Thyroid cancer is rare and accounts for roughly 1% of all new malignant disease with a male to female ratio of 1:3 [1]. Follicular thyroid cancer (FTC) is a well-differentiated thyroid cancer that accounts for 15-20% of cases [2,3].…”

“…Follicular thyroid cancer (FTC) is a well-differentiated thyroid cancer that accounts for 15-20% of cases [2,3]. Thyroid cancer initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases [1]. FTC metastasizes to bone in 2-13% of patients with the spine being the most common bony metastatic site [4].…”

Solitary Spinal Epidural Metastasis from Gastric Cancer

“…Regarding the route of metastasis to the spine, Batson [ 3 ] proposed that an epidural internal vertebral venous plexus and a vertebral venous plexus distributing in the vertebra communicate closely and that slow blood flow transports cancer cells allowing them to implant in the spine. In other local metastatic routes, tumor cells infiltrate directly from local regions or reach via the cerebrospinal fluid; although this is not common [ 4 ]. In our patient, the route was not infiltration through spinal metastasis, but it was assumed to be solitary metastasis to the epidural space via the Batson venous plexus.…”