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Case Reports
. 2015 Nov 16;3(11):946-50.
doi: 10.12998/wjcc.v3.i11.946.

First description of cervical intradural thymoma metastasis

Nicola Marotta  1 , Cristina Mancarella  1 , Davide Colistra  1 , Alessandro Landi  1 , Demo Eugenio Dugoni  1 , Roberto Delfini  1
Affiliations
Case Reports

First description of cervical intradural thymoma metastasis

Nicola Marotta et al. World J Clin Cases. .

Abstract

Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic" (types A, AB, B1, B2, and B3) and "non-organotypic" (thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma.

Keywords: Intradural lesion; Metastasis; Spinal surgery; Spinal tumor; Thymoma.

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Figures

Figure 1
Figure 1
Maximum intensity projection reconstruction from computed tomography images shows C5-Th1 stabilization after the first intervention.
Figure 2
Figure 2
Cervical spine magnetic resonance imaging. A: A C5-C7 lesion with homogeneous enhancement after gadolinium administration in the T1-weighted sequences; B: T2 weighted sequences showing the enclosed spinal cord; C: Especially on the left side (red arrow).
Figure 3
Figure 3
The immunohistochemical examination demonstrated positivity of neoplastic cells for (A) CK19, (B) p63 and (C) CD1a positive T-cells.
Figure 4
Figure 4
Magnetic resonance imaging of the cervico-thoracic spine at 3-mo follow-up showing (A) a small residual tumor, especially anteriorly to the cervical spinal cord and (B) axial view (red arrow).
Figure 5
Figure 5
Cervical magnetic resonance imaging after radiation treatment showing (A) almost total disappearance of the mass and (B) axial view (red arrow).
See this image and copyright information in PMC

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