Spinal metastasis of thymic carcinoma as a rare manifestation: a summary of 7 consecutive cases

Surgical management of spinal intradural metastatic pathologies: a case-based review

Intradural spinal metastases significantly impair neurological function and quality of life, necessitating multimodal, palliative management to preserve mobility and alleviate pain. The effectiveness of systemic chemotherapy and radiotherapy is limited due to the blood-spinal cord barrier and the tumours' radioresistance, respectively. This highlights the urgency for alternative treatments given the rapid neurological decline. Surgical intervention becomes crucial, focusing on maximum tumour debulking to enhance disease control, restore ambulation, and palliate symptoms without compromising neurological function. Achieving this involves meticulous preoperative planning and aggressive intraoperative neuromonitoring. Combining surgery with adjuvant therapies may improve local control and potentially delay recurrence. This case-based review emphasizes the surgical considerations and outcomes in two cases of intradural spinal metastases, underscoring the value of surgery in multimodal therapy.

Metastatic Thymic Carcinoma on Restaging 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography

Thymic carcinoma is a rare thymic epithelial cancer which is not only locally invasive but also highly aggressive disease. The prognosis for this cancer is poor and the surgery remains the mainstay of treatment. Thymic carcinomas have been shown to metastasize to the lymph nodes, lung, and liver. A 63-year old male who was successfully treated for thymic cancer in 2015, presented with metastatic disease recurrence to the spinal cord. We share interesting images of the spinal cord lesions as well as pituitary metastases that were incidentally detected on restaging 18F-fluorodeoxyglucose positron emission tomography-computed tomography.

Treatment strategy and prognostic analysis of spinal metastases from thymomas: A retrospective study from a single center

OBJECTIVE

Thymomas are rare in clinical practice, and cases of metastatic spinal thymoma are extremely scarce, with only a few case reports or case series described in the literature. In this study, we characterized the clinical features, treatment options and prognostic analysis of patients with metastatic spinal thymomas.

PATIENTS AND METHODS

This study included seven patients with metastatic spinal thymoma who underwent open surgery or minimally invasive surgery, and adjuvant treatment in a single center of Peking Union Medical College Hospital from 2010 to 2019. The basic clinical data of the patients were analyzed retrospectively. The possible prognostic factors of progression-free survival (PFS) and overall survival (OS) were studied using the Kaplan-Meier method.

RESULTS

This retrospective study included six male patients and one female patient, with a median age of 58.4 (47-75) years. The time from initial diagnosis to detection of spinal metastasis was 54.2 (30-108) months. Kaplan-Meier survival analysis showed the number of spinal metastasis and adjuvant therapies were favorable factors for improving OS and PFS in patients with metastatic spinal thymomas.

CONCLUSION

Radiation therapy after the primary operation is an efficient adjuvant therapy, since patients who received postoperative radiation treatment have longer OS and PFS than those who receive chemoradiotherapy. The number of spinal metastases seems to be an effective prognostic factor for longer OS and PFS of patients with spinal metastasis of thymoma.

Spine Metastasis of Thymic Carcinoma in a Pediatric Patient: A Case Report and Comprehensive Literature Review

INTRODUCTION

Thymic carcinoma metastases of the spinal column are very rare, especially in pediatric patients. To our knowledge, this is the first such pediatric case in the literature.

CASE PRESENTATION

We report the case of a 14-year-old male patient with T12 and L1 metastases of thymic carcinoma. He had history of thymectomy and intrathoracic tumor resection 7 months previously. The patient's neurological condition deteriorated; therefore, tumor resection and decompression of the spinal canal were performed. He underwent instrumentation and fusion procedures to prevent spinal instability.

CONCLUSION

The main purpose of the treatment is gross total resection of the thymic carcinoma. However, adjuvant methods such as radiotherapy and chemotherapy should be added to the treatment protocol in patients who have higher stage diseases or those in whom total tumor resection cannot be achieved.

Thymoma dissemination through the thoracic intervertebral foramen: Pleural recurrence resulting in spinal cord compression

Background:

Spinal dissemination of thymic tumors is rare but should be considered in the differential diagnosis of thoracic dumbbell-shaped lesions and/or vertebral tumors, irrespective of the time since the initial diagnosis.

Case Description:

A 63-year-old man, with a history of invasive type AB thymoma treated 21 years ago, newly presented to the hospital with a dumbbell-shaped T8-T9 lesion compressing the spinal cord. A review of the literature showed only 16 previous cases of thymic tumors with thoracic spine involvement. Here, we report the lengthiest interval between the initial tumor diagnosis and the detection of spinal involvement, that was secondary to a pleural recurrence from his thymoma. The patient did well following successful excision of the intraspinal mass which had encased the T8 nerve root.

Conclusion:

Spinal dissemination of thymic tumors can occur due to vertebral metastasis or to extension of a pleural recurrence through the intervertebral foramen. Definitive treatment for spinal lesions should be considered to provide adequate cord decompression.

Surgical management of spinal metastases of thymic carcinoma: A case report and literature review

RATIONALE

Metastatic thymic carcinoma in the spine is a rare disease with no standard curative managements yet. The objective of this study is to report a very rare case of spinal metastases of thymic carcinoma successfully operated by combination of instrumentation and cement augmentation together with adjuvant treatment. The management of these unique cases has yet to be well-documented.

PATIENT CONCERNS

A 57-year-old man presented with a 6-month history of continuous and progressive back pain. The patient, who had been diagnosed of thymic carcinoma (stage IV B) for 3 years, received surgical treatment of median sternotomy thymectomy, followed by 3 cycles of chemotherapy and 12 cycles of radiotherapy.

DIAGNOSIS

Magnetic resonance imaging (MRI) of spine showed spinal cord compression secondary to the epidural component of the T4 mass, with increased metastatic marrow infiltration of the left T4 vetebral body, which presented as a solid tumor. Post-operative pathology confirmed the diagnosis of spinal metastases of thymic carcinoma.

INTERVENTIONS

The patient underwent exploratory surgery, circumferential spinal cord decompression, cement augmentation and a stabilization procedure via a posterior approach.

OUTCOMES

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month follow-up visit. There were no other complications associated with the operation during the follow-up period.

LESSONS

Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Metastatic thymic carcinoma of the spine, although rare, should be part of the differential diagnosis when the patient has a history of thymic carcinoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymic carcinoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.

Successful treatment of malignant thymoma with sacrum metastases: A case report and review of literature

RATIONALE

Malignant thymoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of recurrent malignant thymoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with 2 operations combined with stabilization and cement augmentation. The management of these unique cases is not well-documented.

PATIENT CONCERNS

A 75-year-old man presented with lumbosacral pain, radiating pain and numbness of the left extremity. The patient underwent thymectomy in 2008, and posterior spinal cord decompression, tumor resection and a stabilization procedure in 2011. Pathologic results confirmed malignant thymomas of the spine. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction.

DIAGNOSES

We believe this is a less-documented case of metastatic thymoma of the sacral spine presenting with back pain and radiculopathy, and presenting as a giant solid tumor.

INTERVENTIONS

The patient underwent osteoplasty via a posterior approach. Pathologic results confirmed malignant thymomas of the sacral spine.

OUTCOMES

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month and 1-year follow-up visit. There were no other complications associated with the operation during the follow-up period.

LESSONS

This article emphasizes metastatic thymoma of the spine, although rare, should be part of the differential when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.