An Unusual Case of Cauda Equina Secondary to Spinal Metastasis of Thyroid Cancer

Document Type : Case Report

Authors

Department of Otorhinolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan.

Abstract

Introduction:
Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.
 
Case Report:
We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid.
 
Conclusion: 
Metastatic workup of spinal metastasis should include evaluation of the thyroid gland.

Keywords

Main Subjects


1. Sherma SI. Thyroid carcinoma. The Lancet 2003; 361(9356):501-11.
2. Muresan M, Olivier P, Leclère J, Sirveaux F, Brunaud L, Klein M, Zarnegar R, Weryha G. Bone metastases from differentiated thyroid carcinoma. Endocrine-related cancer2008;15(1):37-49.
3. Wilson P, Millar B, Brierley J. The management of advanced thyroid cancer. Clinical Oncology 2004; 16(8):561-8.
4. Sciubba DM, Petteys RJ, Kang S, Than KD, Gokaslan ZL, Gallia GL, Wolinsky J-P. Solitary spinal metastasis of Hürthle cell thyroid carcinoma. Journal of Clinical Neuroscience 2010;17(6):797-801.
5. Rodrigues G, Ghosh A. Synchronous bony and soft tissue metastases from follicular carcinoma of the thyroid. Journal of Korean Medical Science 2003; 18(6):914-6.
6. R Shaha A, P Shah J, R Loree T. Differentiated thyroid cancer presenting initially with distant metastasis. The American journal of surgery 1997; 174(5):474-6.
7. Girelli M, Casara D, Rubello D, Piccolo M, Piotto A, Pelizzo M, Busnardo B. Metastatic thyroid carcinoma of the adrenal gland. Journal of endocrinological investigation1993;16(2):139-141.
8. Hindié E, Zanotti-Fregonara P, Keller I, Duron F, Devaux J-Y, Calzada-Nocaudie M, et al. Bone metastases of differentiated thyroid cancer: impact of early 131I-based detection on outcome. Endocrine-related cancer 2007;14(3):799-807.
9. Wexler JA. Approach to the thyroid cancer patient with bone metastases. Journal of Clinical Endocrinology and Metabolism 2011;96(8):2296-307.
10. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli J, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. Journal of Clinical Endocrinology & Metabolism 2006;91(8):2892-9.
11. Eustatia-Rutten C, Romijn J, Guijt M, Vielvoye G, Van den Berg R, Corssmit E, et al. Outcome of palliative embolization of bone metastases in differentiated thyroid carcinoma. Journal of Clinical Endocrinology & Metabolism 2003; 88(7): 3184-9.
12. Kiml Y-S. Metastatic follicular thyroid carcinoma to the thymus in a 35-year-old woman. Yonsei medical journal 2002;43(5):665-9.
13. McCormack KR. Bone metastases from thyroid carcinoma. Cancer 1966;19(2):181-4.
14. Demura S, Kawahara N, Murakami H, Abdel-Wanis ME, Kato S, Yoshioka K, et al. Total en bloc
 
spondylectomy for spinal metastases in thyroid carcinoma: Clinical article. Journal of Neurosurgery: Spine 2011; 14(2):172-6.
15. Bernier M-O, Leenhardt L, Hoang C, Aurengo A, Mary J-Y, Menegaux F, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. Journal of Clinical Endocrinology & Metabolism 2001; 86(4):1568-73.