Marotta Nicola, Mancarella Cristina, Colistra Davide, Landi Alessandro, Dugoni Demo Eugenio, Delfini Roberto
Nicola Marotta, Cristina Mancarella, Davide Colistra, Alessandro Landi, Demo Eugenio Dugoni, Roberto Delfini, Department of Neurology and Psychiatry, Division of Neurosurgery, University of Rome "Sapienza", 00161 Rome, Italy.
World J Clin Cases. 2015 Nov 16;3(11):946-50. doi: 10.12998/wjcc.v3.i11.946.
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.
胸腺瘤和胸腺癌是罕见的上皮性肿瘤，起源于胸腺。根据世界卫生组织的分类，胸腺瘤有“器官样型”（A型、AB型、B1型、B2型和B3型）和“非器官样型”（胸腺癌）。B3型胸腺瘤是侵袭性肿瘤，可发生转移。由于这些病变罕见，文献中仅描述了7例硬膜外转移病例。我们报告了首例也是唯一一例患有颈段硬膜内B3型胸腺瘤转移的男性病例。一名46岁男性接受了胸腺瘤手术切除。术后一年，他因壁层胸膜转移接受了治疗。2006年，他接受了颈胸段硬膜外转移灶切除及C5-Th1节段固定术。七年后，他前来就诊，主诉左侧颈臂部疼痛及左臂力量减弱。他接受了颈椎磁共振成像检查，结果显示C5-C7水平有一个新病变。该患者接受了硬膜内B3型胸腺瘤转移灶手术。尽管切除不完全，但神经症状有所改善。他术后接受了放疗，肿块进一步缩小。脊柱转移极为罕见。迄今为止，文献中仅描述了7例脊柱硬膜外转移病例。这是首例脊柱硬膜内转移病例。早期发现这些肿瘤并进行手术治疗可改善脊髓受压患者的神经功能预后。包括新辅助化疗、手术和术后放疗在内的多模式治疗似乎可提高转移性胸腺瘤患者的生存率。
