Early post-surgical recurrence of metastatic vertebral neuro-endocrine tumour treated effectively with chemo-radiotherapy

Abstract

Spinal metastasis of neuro-endocrine tumours (NETs) usually arise from a primary in the lung. We encountered such a patient with NET metastasis to T6 vertebra causing severe cord compression. Considering the neurological status, immediate decompression surgery along with T3-T8 posterior stabilization was done. Early recurrence of the tumour causing near total obliteration of the spinal canal leading to significant neurological compromise was noted within one month of surgery. A second surgery at this stage was avoided due to the risk involved and concurrent chemo-radiotherapy was initiated. The tumour was sensitive to chemo-radiotherapy and rapid resolution was noted on subsequent follow-up visits. With appropriate rehabilitation, patient regained full power to become ambulant with support. This case report highlights a rare, early and aggressive recurrence of metastatic vertebral NET following index surgery which was effectively managed with chemo-radiotherapy.

Fig. 1

Sagittal MRI images. (A) T1 sagittal cut MRI image showing T6 vertebral involvement. (B) T2 sagittal cut MRI image showing clearly the epidural extension and spinal canal stenosis.

Fig. 2

Axial cut MRI images showing the cord compression. (A) Contrast enhanced. (B) T2.

Fig. 3

Computerised tomography (CT) images showing the T6 vertebral involvement. (A) Sagittal cut. (B) Coronal cut. view. (B) Lateral view. (C) Axial Cut.

Fig. 4

Post-operative X-ray images. (A) Antero-posterior view. (B) Lateral view.

Fig. 5

Metastatic tumour cells with scanty to moderate amount of eosinophilic cytoplasm in the marrow spaces. H & E, 100x.

Fig. 6

One month post-surgical MRI axial cut image showing near total obliteration of the spinal canal due to the aggressive tumour growth.

Fig. 7

Repeat MRI at final follow-up showing resolution of the tumour. (A) T2 sagittal cut. (B) T1 axial cut. (C) T2 axial cut.