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Washington University Experience | MISCELLANEOUS | Amyloidoma | 5A0 Case 5 History
Case 5 History ---- Amyloidoma (AANP Diagnostic slide session 2010, Case 2) ---- A 68 y/o Caucasian male presented with pain in the mid-thorax radiating around his right side and unsteadiness of gait. Examination revealed a T6 sensory level and spastic paraparesis. Bowel and bladder function were intact. Thoracic MRI demonstrated an erosive extradural lesion involving the right 6th rib and vertebra with compression of the spinal cord. The patient underwent thoracic laminectomy and removal of the epidural mass which was diagnosed as CPPD crystalline disease versus hydroxyapatite deposition. The patient improved after the laminectomy. Approximately 1.5 years later, the patient's symptoms recurred with increasing axial back pain. MRI demonstrated progression of the bony involvement with a new epidural component encasing and compressing the spinal cord, and extending into the paraspinal tissues on the right side. A radical excision of the entire process via a posterior approach was performed. A thoracic MRI showed an erosive extradural lesion involving the right 6th rib and vertebra with compression of the spinal cord. Decompression was completed without further mass removal to preserve neurological function. ---- One and a half years later, symptoms returned. MRI showed progression of the bony involvement and a new epidural component encasing and compressing the spinal cord and extending into the right paraspinal tissues. ---- Radical excision of the entire process was performed. ---- A diagnosis of primary solitary amyloidoma was made.
