Myasthenia Graves with Malignant Thymoma and Spinal Metastasis (P04.097)

Abstract

Objective: Case report of rare spinal metastasis of malignant thymoma. Background Malignant Thymoma is a rare mediastinal tumor. About 15% have extrathoracic metastasis in liver, kidney and bone. Spinal metastasis are exceptional. We present 2 cases of malignant thymoma with spinal metastasis and poor response to chemotherapy and radiotherapy. Design/Methods: CASE REPORT: Case 1: 55years old Emirati presented in 1995 with difficulty in chewing and shortness of breath and was diagnosed as sero-positive myasthenia with thymoma. She underwent surgery followed by chemotherapy and radiotherapy. 2002 she presented with paraspinal pain with multiple metastasis in liver, para aortic lymph nodes. She had extensive surgery followed by chemotherapy and radiotherapy. 2009, she had new liver metastasis and she was started on Sutent. June 2011 she presented with progressive weakness of both legs, back pain and was found to have spinal metastasis from T5-T8. She is on chemotherapy at present. Case 2: 22 years old lebenese lady presented with persistant cough in 1998 and MRI thoracic- revealed enlarged thymus extending to the posterior chest wall. Surgery revealed Cortical Thymoma-lymphocyte type. This recurred in 2000 and she underwent chemotherapy and radiotherapy. Aug 2005 she developed, numbness, weakness in both lower extremities and bladder invovement. CT Chest showed multinodular paraspinal mass going into the intraspinal compartment at D6/7 for which she underwent surgery ,chemotherapy and radiotherapy. April 2007 developed huge cervical lymphadenopathy and biopsy revealed diffuse large cell lymphoma. This was followed by chemotherapy but patient succumbed in 2008. Results: Both our cases relapsed inspite of all available therapy given. Conclusions: Spinal metastasis with malignant thymoma is rare but any back pain or symptoms of spinal cord involvement should alert the physician of spinal metastasis. No definitive treatment is present. Disclosure: Dr. Thakre has nothing to disclose. Dr. Inshasi has nothing to disclose.