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Case report
peer-reviewed

Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature



Abstract

Papillary thyroid carcinoma (PTC) is significantly more common than follicular thyroid carcinoma (FTC), yet FTC has a much higher tendency to metastasize to the spinal column. We present a rare case of a metastatic thoracic spinal column lesion originating from the PTC. Thyroid carcinoma is known to be highly vascular with a significant tendency to hemorrhage during surgical resection. This increased tendency to hemorrhage leads to unanticipated intraoperative risks when the type of cancer is not diagnosed before surgical resection. Complications related to intraoperative bleeding can be prevented by visualization using angiography and preoperative embolization. The type of cancer is ideally diagnosed before tumor resection either by the standard metastatic workup or histologically after the biopsy. However, limitations exist in these methods, therefore, hypervascular tumors such as metastatic thyroid cancer can go undiagnosed until after surgical resection. In addition to our case report, we present a review of the literature regarding diagnostic and treatment strategies for hypervascular thyroid tumors and propose a new algorithm for the surgical management of spinal tumors with an unknown origin for optimization of preoperative and perioperative care.



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Case report
peer-reviewed

Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature


Author Information

Ariel Takayanagi

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Omid R. Hariri Corresponding Author

Department of Neurosurgery, Stanford University School of Medicine

Hammad Ghanchi

Department of Neurosurgery, Riverside University Health System-Medical Center, Moreno Valley, California, United States

Dan E. Miulli

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Frank Vrionis

Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States

Farbod Asgarzadie

Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, United States


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature


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Case report
peer-reviewed

Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature

  • Author Information
    Ariel Takayanagi

    Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

    Omid R. Hariri Corresponding Author

    Department of Neurosurgery, Stanford University School of Medicine

    Hammad Ghanchi

    Department of Neurosurgery, Riverside University Health System-Medical Center, Moreno Valley, California, United States

    Dan E. Miulli

    Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

    Javed Siddiqi

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

    Frank Vrionis

    Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States

    Farbod Asgarzadie

    Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, United States


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: April 03, 2017

    DOI

    10.7759/cureus.1132

    Cite this article as:

    Takayanagi A, Hariri O R, Ghanchi H, et al. (April 03, 2017) Unusual Metastasis of Papillary Thyroid Cancer to the Thoracic Spine: A Case Report, New Surgical Management Proposal, and Review of the Literature. Cureus 9(4): e1132. doi:10.7759/cureus.1132

    Publication history

    Received by Cureus: March 12, 2017
    Peer review began: March 14, 2017
    Peer review concluded: March 29, 2017
    Published: April 03, 2017

    Copyright

    © Copyright 2017
    Takayanagi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Papillary thyroid carcinoma (PTC) is significantly more common than follicular thyroid carcinoma (FTC), yet FTC has a much higher tendency to metastasize to the spinal column. We present a rare case of a metastatic thoracic spinal column lesion originating from the PTC. Thyroid carcinoma is known to be highly vascular with a significant tendency to hemorrhage during surgical resection. This increased tendency to hemorrhage leads to unanticipated intraoperative risks when the type of cancer is not diagnosed before surgical resection. Complications related to intraoperative bleeding can be prevented by visualization using angiography and preoperative embolization. The type of cancer is ideally diagnosed before tumor resection either by the standard metastatic workup or histologically after the biopsy. However, limitations exist in these methods, therefore, hypervascular tumors such as metastatic thyroid cancer can go undiagnosed until after surgical resection. In addition to our case report, we present a review of the literature regarding diagnostic and treatment strategies for hypervascular thyroid tumors and propose a new algorithm for the surgical management of spinal tumors with an unknown origin for optimization of preoperative and perioperative care.



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Create a free account to continue reading this article.

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Ariel Takayanagi

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Omid R. Hariri, D.O., M.Sc.

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
ohaririucla@gmail.com

Hammad Ghanchi

Department of Neurosurgery, Riverside University Health System-Medical Center, Moreno Valley, California, United States

Dan E. Miulli

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Frank Vrionis

Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States

Farbod Asgarzadie

Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, United States

Ariel Takayanagi

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Omid R. Hariri, D.O., M.Sc.

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
ohaririucla@gmail.com

Hammad Ghanchi

Department of Neurosurgery, Riverside University Health System-Medical Center, Moreno Valley, California, United States

Dan E. Miulli

Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Frank Vrionis

Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States

Farbod Asgarzadie

Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, United States