Systemic Amyloidosis with Predominant Spine Involvement: A Case Report

In November 2011 a 57-year old man, with a 3 months history of back pain, was admitted at the Emergency Department because of difficulty maintaining upright position. He was admitted in our Department for an incomplete paraplegia with hypertonus, exhaustible bilateral clonus and acute urinary retention.

The CT scan and MRI showed a pathological fracture of T7 with the presence of a large soft tissue mass narrowing the spinal canal for more than 50% of its diameter (Figure 1 A-B). Anamnesis was negative for cancer and only revealed a history of HBV-related steatosis.

Laboratory tests showed elevation of Ca 19-9 (263.4), Ca 125 (96.1), alkaline phosphatase (199) and γ GT (325); at that time there was no serum monoclonal component. After arteriography and selective embolization (with pathological finding of a modest circle), he underwent urgently to tumor debulking, decompression and stabilization from T5 to T9 (Figure 2 A-B).

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