Primary thoracic spine amyloidoma causing malignant cord compression: A case report and review of the literature

Abstract

Purpose

Amyloidoma is a rare pseudo-tumoral form of localised amyloidosis. This condition is thought to rarely affect the spine, with less than 100 cases of spinal amyloidomas described in literature and their properties are not well understood. Recognising the imaging features of this condition and the appropriate management are essential for patient outcomes.

Content

A case of a thoracic spine amyloidoma is described and a literature review conducted of all cases of thoracic spine amyloidoma to identify common imaging characteristics, diagnostic criteria and management.

Results

27 cases of thoracic spine amyloidoma are found in the literature. 21 were included in the review. Common plain radiograph and CT characteristics demonstrated a calcified osteolytic lesion which was destructive. Common MRI characteristics demonstrated hypointensity on T1 and T2 weighted imaging with a degree of variability and variable enhancement after contrast. Most cases utilised surgical resection of mass and all required histological analysis to confirm diagnosis. Surgical management had proven benefit for neurological outcomes and low rates of recurrence. There was little evidence for the benefit of adjuvant therapy as management.

Conclusion

A diagnosis of a thoracic spine amyloidoma should be considered for a calcified lesion which presents as osteolytic on plain radiograph and demonstrates hypointensity on T1 and T2 weighted MRI imaging. However, a sample of the mass and subsequent histological analysis is diagnostic. Surgery has proven benefit for outcomes however comparative studies are needed to determine the role of adjuvant therapy in this condition.