Differential Diagnosis Of Spinal Lesions Research Articles

Tumoral calcinosis in the cervical spine: a case report and review of the literature

BackgroundTumoral calcinosis is rarely located in spine. A 55-year-old Japanese woman with cervical tumoral calcinosis is presented, along with a review of the literature relating to tumoral calcinosis in the spine. We discussed the etiology, diagnosis, and management of this condition.Case presentationWe report a case of a patient with cervical tumoral calcinosis with end-stage renal disease. A computed tomography scan showed a lobulated, calcified mass around the right facet joint at the fourth-fifth cervical spine and calcifications were also observed in the right intervertebral foramens at fourth-fifth cervical spine and fifth-sixth cervical spine levels and the anterior wall of the spinal canal. By performing a cervical decompression and stabilization, the patient recovered from her neurological symptoms.ConclusionsAlthough tumoral calcinosis is rarely located in the spine, it should be considered in the differential diagnosis of spinal lesions. If a calcified mass causes acute neurological symptoms, resection of the mass is still the most important treatment.

The added value of SPECT/CT imaging for diagnosing benign and malignant lesions of spine

Objective To evaluate the added value of SPECT/CT imaging in identifying the spinal hot spots of 99Tcm-MDP imaging. Methods From January 2012 to December 2013 a total of 103 patients (49 males, 54 females; average age: 62.1 years) with spinal hot spot by whole-body bone imaging were retrospectively analyzed. Patients underwent SPECT/CT imaging 180 min after 99Tcm-MDP injection. Images of whole body bone imaging and SPECT/CT imaging were analyzed. Final diagnosis was determined by pathological examination, trans-spinal biopsy or follow-up (≥6 months). Results There were 149 spinal lesions in 103 patients. The planar bone imaging detected 37 benign and malignant lesions (24.8%, 37/149), and SPECT/CT imaging detected 132 benign and malignant lesions(88.6%, 132/149). Moreover, SPECT/CT images provided additional confidence for image interpretation (helpful 91.3%(136/149), unsure and not helpful 8.7%(13/149)). Conclusion SPECT/CT imaging provides more information than planar whole body bone imaging in differential diagnosis of spinal lesions. Key words: Spinal diseases; Neoplasm metastasis; Skeleton; Tomography, emission-computed, single-photon; Tomography, X-ray computed; MDP

Giant cell tumor of the spine masquerading as spinal tuberculosis: An uncommon entity

The spine is an infrequent location for giant cell tumor (GCT). The incidence of GCT in the spine, above sacrum, is only 1%-1.5%. We report a case of recurrent GCT of the lumbar spine which was clinically diagnosed as spinal tuberculosis. A 24-year-old female presented with complaints of pain in the right leg during the last trimester of her pregnancy. One month later, she complained of retention of urine along with weakness in both the lower limbs. X-ray showed destruction and sclerosis of L3 vertebra with involvement of the adjacent discs. The magnetic resonance imaging showed severe compression and collapse of L3 vertebra with diffusely altered marrow signals and an associated expansible lobulated soft tissue component. With a provisional clinical diagnosis of spinal tuberculosis, the mass was decompressed and sent for histopathological examination, where it was diagnosed as GCT of the spine. Follow-up details were not available. However, the patient presented with similar complaints 6 months later. A near total resection of the tumor was done with fixation of the spine. Histopathology confirmed it as GCT. Although rare, still GCT needs to be considered in the differential diagnosis of spinal lesions so that specific treatment modality may be provided to the patient.

Intraspinal leiomyoma: A case report and literature review.

Leiomyomas are benign tumors which are predominantly found in the genitourinary and gastrointestinal tracts. Leiomyomas in the spine are extremely rare. The current study presents a case of a 35-year-old female with intraspinal leiomyoma who presented with low back pain and weakness in the left leg of two months. Computerized tomography and magnetic resonance imaging revealed an epidural mass at the T11–12 levels. The patient underwent a T11–12 laminectomy through posterior approach, achieving total removal of the tumor with a well-demarcated dissection plane. Pathological examination demonstrated a leiomyoma. Postoperatively, the patient showed a significant improvement in neurological function. Although intraspinal leiomyoma is extremely rare, it should be considered in the differential diagnosis of spinal lesions in females. The diagnosis is predominantly dependent on a pathological examination. Gross total resection is recommended for its treatment, however the prognosis remains poor. Post-operative hormonal therapy may be useful in controlling tumor recurrence.

Unusual Case of Metastatic Gastrointestinal Adenocarcinoma to the Cervical Spine without a Detectable Primary Source in a Patient with Acquired Immunodeficiency Syndrome: A Case Report

The authors report a case of metastatic gastrointestinal adenocarcinoma to the cervical spine in a patient with acquired immunodeficiency syndrome (AIDS) being treated with antiretroviral therapy. The source of this tumor could not be identified despite a thorough evaluation. A 49-year-old male being treated for AIDS presents with worsening neck pain and left distal arm weakness. MRI demonstrated an erosive mass within the cervical four vertebral body extending through the pedicle on the left side. Patient underwent needle biopsy followed by combined anterior and posterior fusion procedures. Pathology demonstrated metastatic gastrointestinal adenocarcinoma without known primary origin. He is currently undergoing palliative radiotherapy. This is an unusual case of metastatic gastrointestinal adenocarcinoma to the cervical spine. This should be included on the differential diagnosis of spinal lesions in this patient population and may represent a unique tumor in patients with HIV/AIDS who are on immunosuppressive therapy.

Concurrent schwannoma and intradural neuroma after resection of a cauda equina schwannoma. A case report and first description

We present the case of a 33-year-old female complaining of recurrent pain and sensory disturbance in both legs, 3 years after the removal of a schwannoma at the level of L2/3. Magnetic resonance imaging showed two lesions at the site of the previous operation. Assuming tumour recurrence, the patient was referred for surgery. Intraoperatively, both an intradural neuroma and a schwannoma were found. Histopathological assessment confirmed the diagnosis of both coexisting entities. Neuroma should be considered in the differential diagnosis of spinal lesions, particularly in the assumption of recurrence.

Spinal chondrosarcoma following adenocarcinoma of the breast: case report

BACKGROUND Chest wall chondrosarcomas have been reported rarely in breast cancer patients treated with chest wall radiation therapy. However, there are no prior reports of spinal chondrosarcomas arising in patients with a history of breast adenocarcinoma. CASE DESCRIPTION A neurologically intact 53-year-old woman with breast adenocarcinoma and new onset back pain was evaluated. Magnetic resonance imaging of the spine revealed a tumor of the posterior elements of T7, impinging upon the spinal cord. A computed tomography guided needle biopsy of the spinal mass failed to yield diagnostic results. The patient underwent an open surgical biopsy and complete excision of a low-grade chondrosarcoma. The patient’s thoracic pain resolved after surgical excision of her thoracic tumor. She remained neurologically intact. Pathological examination of the tumor revealed a low-grade chondrosarcoma. CONCLUSION We present the first reported case of chondrosarcoma of the spine arising in a patient with a history of breast adenocarcinoma without prior irradiation. Solitary spinal tumors in patients with breast adenocarcinoma should not be assumed to be metastatic lesions, and chondrosarcoma should be included in the differential diagnosis of spinal lesions in this patient population. Experimentally, chondrosarcomas have been shown to be sensitive to circulating levels of estrogens, and this might explain an association with adenocarcinoma of the breast treated with tamoxifen.