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Transcatheter arterial embolization for relapsed spinal metastatic paraganglioma: A case report.

ABSTRACT: Spinal metastasis is a rare presentation of paraganglioma and an effective therapy for nonresectable spinal metastatic paraganglioma (MPG) has not yet been established. We report the case of a 42-year-old woman with metastatic spinal cord compression caused by a relapsed spinal MPG after decompressive surgery. We performed transcatheter arterial embolization (TAE) in addition to systemic chemotherapy. After TAE, the neurologic symptoms improved, and the back pain was reduced. After 3 sessions of TAE, MRI revealed that the tumor at the level of the seventh thoracic vertebra had shrunk and the pressure on spinal cord had decreased. TAE might be a feasible treatment option for spinal MPG, even after surgery or irradiation.

SUBMITTER: Makino W

PROVIDER: S-EPMC6536615 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Transcatheter arterial embolization for relapsed spinal metastatic paraganglioma: A case report.

Makino Wataru W Heianna Joichi J Toguchi Masafumi M Teruya Taiki T Murayama Sadayuki S

Radiology case reports 20190524 8

Spinal metastasis is a rare presentation of paraganglioma and an effective therapy for nonresectable spinal metastatic paraganglioma (MPG) has not yet been established. We report the case of a 42-year-old woman with metastatic spinal cord compression caused by a relapsed spinal MPG after decompressive surgery. We performed transcatheter arterial embolization (TAE) in addition to systemic chemotherapy. After TAE, the neurologic symptoms improved, and the back pain was reduced. After 3 sessions of ...[more]

PMID: 31193579

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Project description:BackgroundLutetium 177 (177Lu) - DOTATATE is a form of peptide receptor radionuclide therapy (PRRT) utilized in the treatment of neuroendocrine tumors. Data on 177Lu-DOTATATE-induced thyroid dysfunction is limited.Case descriptionA 29-year-old male with SDHB positive metastatic paraganglioma enrolled under the 177Lu-DOTATATE trial (NCT03206060) underwent thyroid function test (TFT) evaluation comprised of thyroid stimulating hormone (TSH) and free thyroxine (FT4) immunoassay measurements per protocol prior to 177Lu-DOTATATE therapy. The TSH was suppressed [<0.01 µIU/ml (0.27-4.2 µIU/ml)], and FT4 was normal [1.3 ng/dl (0.9-1.7 ng/dl)]. The TSH receptor antibody and thyroid stimulating immunoglobulin index were undetectable [<1 IU/L (≤1.75 IU/L), and <1 (≤1.3) respectively], while the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies were elevated [605 IU/ml (0.0-34.9 IU/ml), and 178 IU/ml (0.0-40.0 IU/ml) respectively]. Mass spectrometry on a stored (-80°C) plasma sample obtained one-month pre-PRRT revealed elevated total triiodothyronine (TT3) [235 ng/dl (65-193 ng/dl)] and FT4 [3.9 ng/dl (1.2-2.9 ng/dl)] levels. The patient was diagnosed with Hashimoto's thyrotoxicosis. However, the patient was asymptomatic. One month after the first dose of 200mCi 177Lu-DOTATATE, the patient noted fatigue and a 2.6 Kg weight gain. The TSH (73.04 µIU/ml), anti-TPO antibodies (>1,000 IU/ml), and anti-Tg antibodies (668 IU/ml) had substantially increased, with reductions in FT4 (0.3 ng/dl) and TT3 [54 ng/dl (87-169 ng/dl)]. Diagnostic gallium 68 - DOTATATE positron emission tomography-computed tomography performed prior to 177Lu-DOTATATE treatment revealed diffuse thyroid uptake. Post-therapy single-photon emission computed tomography also revealed diffuse uptake of 177Lu-DOTATATE in the thyroid gland. Levothyroxine therapy was initiated, and the patient's symptoms resolved.SummaryWe report, for the first time, a patient with asymptomatic primary hyperthyroidism who rapidly developed symptomatic primary hypothyroidism 1 month after 177Lu-DOTATATE therapy, accompanied by marked changes in TFTs and thyroid auto-antibody titers, with functional imaging evidence of diffuse uptake of 177Lu-DOTATATE in the thyroid gland.ConclusionsThyroid dysfunction can be associated with PRRT. Thyroid uptake patterns on pre-treatment diagnostic somatostatin analog scans might predict individual susceptibility to PRRT-associated TFT disruption. Therefore, periodic evaluation of TFTs should be considered in patients receiving PRRT.

Dataset Information

Transcatheter arterial embolization for relapsed spinal metastatic paraganglioma: A case report.

Publications

Transcatheter arterial embolization for relapsed spinal metastatic paraganglioma: A case report.

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