1/22. Vertebral intra-osseous chordoma or giant notochordal rest?Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intraosseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/22. Intraosseous calcifying pseudotumor of the axis: a case report.STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To present the first case of intraosseous calcifying pseudotumor arising from the axis. SUMMARY OF BACKGROUND DATA: Calcifying pseudotumor is a very rare disease. Only 24 cases have been previously reported. methods: A case of calcifying pseudotumor involving the body, dens, and laminae of the axis in a 60-year-old male patient was managed with total laminectomy of the axis and instrumented occipitocervical fusion, followed by the curettage of the body and dens of the axis and autogenous iliac bone graft. medical records, imaging studies, microscopic findings, and related literature are reviewed. RESULTS: Microscopic examination showed amorphous, basophilic, and chondroid calcifying masses surrounded with palisading histiocytes and foreign body-type giant cells. The findings were consistent with those of calcifying pseudotumors previously reported in other sites of the body. At 24 months after operation, a significant reduction of neck pain was achieved. But there was evidence of local recurrence of the lesion in the body and dens of the axis with a local progression of the preexisting lesion in the facet joints. CONCLUSION: This is the first report of intraosseous calcifying pseudotumor arising from the axis.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
3/22. Brown tumor of the thoracic spine in a patient on long-term hemodialysis.A 39-year-old woman on long-term hemodialysis presented with a history of rapidly progressive paraplegia. Radiological examination showed a compression fracture of seventh thoracic vertebra and expansive mass lesion in the posterior elements of the fourth thoracic vertebra. Laboratory tests on admission showed serum calcium of 11.9 mg/dl, phosphate 6.0 mg/dl, and the high-sensitive parathyroid hormone level of 139,191 pg/ml measured by radioimmunoassay. Percutaneous biopsy of the expansive mass showed a large number of multinucleated giant cells in a fibroblastic stroma containing abundant hemosiderin. Tumor resection and anterior interbody fusion with artificial bone graft was performed on 14th hospital day. paraplegia gradually improved postoperatively. Total parathyroidectomy and autotransplantation of parathyroid gland were subsequently performed. Nodular hyperplasia was evident in the parathyroid glands by light microscopy. Brown tumor is rarely found in vertebral bone and this is the sixth case of such tumor in secondary hyperparathyroidism.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
4/22. Unicameral bone cyst of a cervical vertebral body and lateral mass with associated pathological fracture in a child. Case report and review of the literature.The authors present the case of a 10-year-old girl with a history of cervical trauma in whom a cystic lesion was found to involve all three columns of C-7 with evidence of pathological fracture. Computerized tomography scanning revealed a lytic lesion with sclerotic margins involving the left vertebral body, pedicle, lateral mass, and lamina of C-7 with an associated pathological compression fracture. magnetic resonance imaging demonstrated mixed signal on both T1- and T2-weighted sequences, with cystic and enhancing solid portions. magnetic resonance angiography demonstrated anterior displacement of the left vertebral artery at C-7. The patient underwent C-7 subtotal corpectomy and posterior resection of the tumor mass; anterior and posterior fusion were performed in which instrumentation was placed. Histological examination disclosed cystic areas lined by fibromembranous tissue with calcification and osteoid deposits consistent with unicameral bone cyst. Of the four previously reported cases of unicameral bone cysts in the cervical spine, none involved all three columns simultaneously or was associated with pathological fracture. The most common differential diagnostic considerations for cystic lesions in the spine are aneurysmal bone cyst, osteoblastoma, or giant cell tumor of bone. Unicameral bone cyst, in this location, although rare, must be considered in the differential diagnosis and may require resection and spinal reconstruction.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
5/22. Castleman's disease: unusual case of inflammatory spinal dorsal epidural mass: case report.OBJECTIVE AND IMPORTANCE: Castleman's disease (giant lymph node hyperplasia) is a rare, heterogeneous, lymphoproliferative disorder of unknown cause and pathogenesis. Most cases occur as mediastinal masses, although extrathoracic involvement, including nodal and extranodal locations, has been reported. The localized variants (solitary lesions) respond well to surgical excision. CLINICAL PRESENTATION: We report the case of a 34-year-old man with headache, intermittent febrile sense, progressive weakness of the legs, and urinary incontinence. magnetic resonance imaging disclosed an enhancing dorsal extradural mass with impingement on the spinal cord at the T2-T3 level. Other abnormal laboratory findings were increased erythrocyte sedimentation rate and mild leukocytosis. TECHNIQUE: The mass lesion was removed; the histopathological findings included diffuse lymphoid cell infiltration and vascular proliferation, which are compatible with Castleman's disease. CONCLUSION: Although the dorsal epidural site of this case is very unusual, Castleman's disease was considered the most appropriate diagnosis on the basis of the associated systemic findings. This patient with dorsal epidural Castleman's disease may be the first reported case in the literature.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
6/22. erdheim-chester disease: a unique presentation with liver involvement and vertebral osteolytic lesions.erdheim-chester disease is a very rare xanthogranulomatous, non-Langerhans cell systemic histiocytosis with an unknown etiology and pathogenesis. Histologically, it is characterized by a diffuse infiltration with large, foamy histiocytes, rare Touton-like giant cells, lymphocytic aggregates, and fibrosis. The histiocytes differ from the Langerhans cell group in ontogenesis, immunohistochemistry (positive for CD68 and negative for CD1a and S100 protein), and ultrastructural appearance (lack of Birbeck granules). Although most of the cases have symmetric osteosclerosis of the long bones, an involvement of the axial skeleton has also been described. Extraskeletal lesions are present in more than 50% of the patients and may involve the retroperitoneal space, lungs, kidneys, brain, retro-orbital space, and heart. This study presents the case of a patient with erdheim-chester disease with vertebral destruction and, for the first time, to our knowledge, involvement of the liver. The diagnosis is based on radiologic, histologic, immunohistochemical, and ultrastructural findings.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
7/22. Aspiration cytology diagnosis of a primary amyloid tumor of thoracic vertebra: a case report.Isolated primary amyloid tumor of bone is rare; however, preoperative diagnosis can be rewarding because the prognosis is excellent. There are no clinical or roentgenographic criteria that can establish this diagnosis. There are few previous reports of fine-needle aspiration (FNA) where diagnosis of amyloidoma was made retrospectively. They describe the presence of extracellular hyaline material along with plasma cells and lymphocytes. A 35-year-old female was referred to the FNA clinic with swelling in the right upper chest wall. Radiologic findings revealed a destructive lytic lesion involving the bodies of D1 and D2 vertebrae with extension into surrounding soft tissue. Repeated FNA smears were hypocellular but had abundant homogeneous flocculent material, which stained positive with congo red. A few plasma cells and foreign-body giant cells were also seen. We conclude that preoperative FNA cytology diagnosis of amyloid tumor is possible. Hypocellular smears with flocculent material, plasma cells, and foreign-body giant cells in absence of granulation tissue should suggest the diagnosis.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
8/22. Solid variant of aneurysmal bone cyst of the cervical spine.STUDY DESIGN: A case of the solid variant of aneurysmal bone cyst affecting the posterior component of the fourth cervical vertebra is reported. Imaging studies showed an expansile destructive lesion. After curettage, autologous iliac bone grafting with posterior fusion was performed. There was no sign of local recurrence 2 years after surgery. OBJECTIVES: To emphasize the occurrence of the solid variant of aneurysmal bone cyst in the cervical spine. SUMMARY OF BACKGROUND DATA: The solid variant of aneurysmal bone cyst is rare, and only 12 cases occurring in the vertebrae, including 3 in the cervical vertebrae, have been reported. The condition is difficult to diagnose radiologically before biopsy or surgery. methods: A 9-year-old girl presented with pain in the nape of the neck without any neurologic deficit. She was found to have the solid variant of aneurysmal bone cyst in the posterior component of the fourth cervical vertebra, which had destroyed the lamina and spinous process. Part of the posterior aspect of the C4 vertebral body was also involved. curettage of the lesion was performed, and the defect in the posterior component of the vertebra was reconstructed using an autologous iliac bone graft with posterior fusion using a halo vest. RESULTS: magnetic resonance imaging disclosed a homogeneous low intensity mass at the lamina, spinous process, and vertebral body of C4 on T1-weighted images. The mass showed heterogeneous high signal intensity on Gd-enhanced images. Histologically, the resected specimen showed predominant fibroblastic proliferation, with minor foci of reactive osteoid formation and an area of osteoclast-like giant cells. Neither cellular atypia nor mitotic figures were evident. There was no sign of local recurrence 2 years after surgery. CONCLUSIONS: The solid variant of aneurysmal bone cyst should be included in the differential diagnosis of any lytic expansile lesion of the spine, even though it is a destructive lesion. Gd-enhanced magnetic resonance imaging may be helpful for distinguishing the solid variant from conventional aneurysmal bone cyst.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
9/22. Pigmented villonodular synovitis (giant cell tumor of the synovium) occurring in the vertebral column. Report of a case.A case of pigmented villonodular synovitis (giant cell tumor of the synovium) involving the vertebral column is presented. The tumor grew outside the dura and extended to the paravertebral connective tissue, causing sensory and motor disturbance indicative of spinal cord compression. This anatomic location is very rare for lesions of this type, and to our knowledge, this case is only the fifth reported in the English-language literature.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/22. Angio-Behcet with vertebral erosion: an exceptional Behcet's complication and literature review.Behcet's disease is a multisystem disorder commonly seen in japan and in Mediterranean countries characterized by a vasculitis of unknown origin. In this work, we describe a case of a 47-year-old man with Behcet's disease of 28 years evolution who presented with a common lumbago and revealed to have a rare case of destruction of the third lumbar vertebra due to a giant pseudoaneurysm of the right iliac artery. In the discussion, we make a brief review of the literature on the subject and analyze the existence of three similar cases.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
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