15-MAY-2025  GHAZWAN SAMI AMEEN  55 YEARS  EXTRAMEDULARY  HUGE TUMOR DESTROYING THE LEFT SIDE OF D7,8 WITH EXTENSION TO THE LEFT EXTRAPLEURAL CAVITY, EXTENDING TO THE LEFT PARASPINAL MUSCLES, CAUSING PARA-ANALGESIA BELOW D6 AND DEEP PARESIS BOTH LOWER LIMBS.

The patient an Iraqi citizen came to the clinic 13-May-2025 walking with help of 2 persons, telling that 45 days ago got coldness both feet with gradual deterioration. The patient lost sensation to the level of D6 both sides. MRI done 11-May-2025 showing huge mass destroying the left side of D7 and D8, compressing the spinal cord to the right and extending to the left extrapleural space and the left paraspinal muscles. The patient is telling that his condition is deteriorating rapidly the the anesthesia the last 4 days ascend fro the umbilicus up the 5 cm under the nipples.  

On examination, the patient is walking with help. SLRS was 1 degrees without pain right side and 2 degrees without pain in the left due to weakness. There is  complete para=analgesia below the nipples and profound weak both lower limbs. Urination and defecation are preserved.

The patient was sent to more proper investigations and the MRI showed the same data as before, but the spinal cord was seen pushed to the right and spectroscopy showed high lactate . Fibertraking could not catch the spinal cord fibers. Using ORS Visual it showed the bony fractures including the left D7 and 8 ribs confirming that the lesion is malignant. The tumor dimension is 11x10x8 cm,   

With the patient in right side position, skeletonization of D7 and D8 was performed. The extending posterior of the tumor was resected with the eaten laminae and left facets. Incision over the left D8 rib around 20 cm. The rib is eaten by the tumor. The healthy part of the rib was cut and the pleura was pushed up with tumor extrapleurally. The tumor mass was attacked extrapleurally and decompression was achieved. Resection of the tumor to decompress the spinal cord. The patient was bleeding as a hill, that required more the 12 units packed cells and 16 units FFP. After 13 hours the BP was unrecordable, for what hemostasis was achieved and closure of the wounds was done and the patient was sent to the ICU. The biopsy result was metastatic malignant papillary thyroid tumor. Ready Vac drain was inserted extrapleurally.  

In the ICU, blood transfusion, FFP was given and all the homeostatic parameters was observed and corrected accordingly. The paraplegia disappeared and it took 3-4 days to correct all the parameters. The patient was planned to continue the surgery at 26-May-2025 to stabilize the spine. The immunohistologic result was TTF-1 was positive, CK7, thyroglobulin and PAX8 are positive. Napsin A and CK20 were negative.

The tumor was bleeding vigorously, for what so as not to loose the patient, the surgery was stopped after 14 hours and sent to ICU to correct his disturbed homeostasis. After stabilization of his condition, a bonus of 4 days was given and he could set in the bed.