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Título

NEURO-ONCOLOGICAL PERSPECTIVE IN A PATIENT WITH BONE METASTASIS FROM FOLLICULAR THYROID CARCINOMA

RESUMO

Case presentation
A 31-year-old female patient underwent a total thyroidectomy 5 years ago for thyroid tumor resection. Recently, she complained of back pain, having a palpable mass at the site. Hypoesthesia was also noted in the right T10 dermatome. 4 months before the neurological consultation, she performed a CT scan in which an osteolytic expansive lesion was observed on T10 in the proximal portion to the right costal arch. Then an MRI was requested, in which a large tumor was found, reaching the vertebral body of T10 and extending to the right thoracic cavity, so a giant cell tumor was suspected. Thus a biopsy of that tumor was requested and the result was compatible with follicular thyroid carcinoma metastasis. Then, tumor resection surgery was performed, including T10 corpectomy and arthodesis with pedicle screws from T7 to L1. Besides, the patient is being followed up with oncology and is awaiting screenig tests, but the scintigraphy did not show any other bone lesions.

Discussion
Thyroid cancer can evolve to its distant metastic state, such as bone metastases. In a hematogenous route, a carninoma can lead to bone metastasis, with this malignancy occurring in 2-13% of cases of DTC (Differentiated Thyroid Cancer). This specific type of metastasis is more prevalent in follicular cancer (7-28%) than in papillary cancer (1.4-7%). Bone metastases represent a frequent complication, specially in follicular thyroid carcinoma, and cause pain, fractures and spinal cord compression, also is observed hypoesthesia in some dermatomes, so the patient's quality of life is severely reduced. The diagnosis is established by correlating clinical suspicion with neuroimaging, such as whole-body and skeletal MRI, which are essential to locate and assess the extent of lesions. As an adjuvant treatment, radioiodine therapy is indicated to destroy malignant thyroid tumor cells left over from total thyroidectomy. Thus, it eliminates locoregional micrometastases and distant metastases.

Final comments
Since scintigraphy excludes the possibility of another bone lesion, the patient has a good prognosis. According to the neuro-oncological literature, complete remission reaches 20% of clinical cases of bone metastases resulting from follicular thyroid carcinoma, reiterating the matter of radioiodine therapy as an adjuvant treatment. Finally, a clinical improvement in the patient under analysis could already be observed, as the hypoesthesia of the T10 dermatme was reversed.

Palavras Chave

NEURO-ONCOLOGICAL; BONE; METASTASIS; CARCINOMA; FOLLICULAR; THYROID

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