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OF THE
THORACIC SPINE
A Rare Case
ABSTRACT
was a paravertebral mass. MRI of the thoracic spine was also done
tumor. Retrospective analysis of the case revealed that MRI was not
2
INTRODUCTION
body. It is divided mainly into two, the central nervous system and the
system, while the spinal cord and its nerve roots constitute the
between the CNS and other tissues of the body through which many
3
important diagnostic modality for patients with spinal cord tumors. It
modality. And plain x-rays have minimal role in the modern diagnosis
4
CASE REPORT
Clinical Presentation
And (1) one month prior to admission, she noted feeling of heaviness
of both lower extremities while walking, more in the right, causing her
to drag her right leg. She also complained of constipation for three
noted. Past
medical history revealed that she was admitted last 2005 and had an
unremarkable.
with assist.
80%
Relexes : intact
tissue mass in the right hilar area. Fibrocalcific opacities in the left
upper lung were also noted, wherein PTB was considered. The
1) .
6
With the x-ray findings, a demyelinating disease, which is more
of a white matter disease was readily ruled out. Soft tissue mass in the
mediastinum, and the differential diagnosis will greatly vary. Such that,
tomography of the chest, the location of the right hilar mass could
adequately image the spinal cord and its associated nerves. Detail of
7
Thoracolumbar spine x-ray was done on this patient, and the soft
were intact.
rule out any metabolic abnormalities that could cause weakness and
were normal.
MRI of the thoracic spine was then done which revealed a 4.7 x 3.2 cm
intensely than the center. The mass widens the right neural foramina
at the level of T4-T5 and compresses and displaces the spinal cord
A B
C D
Figure 3. MRI of the thoracic spine showing a dumbbell-shaped tumor at the level of
T4-T6, displacing the cord to the left. a) sagitttal contrast enhanced scan showing
heterogenous enhancement , with the periphery of the mass enhancing more
intensely than the center, b) sagittal T2W images showing hyperintense signal of
the tumor, c) axial T1W images showing hypointense signal to the spinal cord, and
d) axial contrast enhanced scan showing heterogenous enhancement.
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Figure 4. Sagittal MRI
of the thoracic spine showing the hypointense lesion in T1W images with
heterogenous enhancement on T2W images. The cord is displaced
anteriorly.
benign intradural spinal tumor, which arise from arachnoid cluster cells
and thus can be seen from the nerve roots. It may occur in any age
group, but mostly in the 5th and 7th decade of life with female
shaped tumor), the most common are nerve sheath tumors which
Management
10
vitamin B-complex, ranitidine and mefenamic acid for symptomatic
Outcome
chondrogenic origin that arises from chondoblasts, cells that form the
cartilage.
3rd post-operative day, she was transferred from the intensive care
Motor : R L Sensory: R
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Lower 3/5 3/5 Lower 100%
100%
Relexes : intact
The patient went for follow-up check-up and for physical rehabilitation
only two times during her 1st post-operative month, and afterwhich,
of both lower extremities nor paresis were noted. Patient now can do
tumor, patient was advised for follow-up CT scan of the thoracic spine
Figure 5. Bone reconstruction of the axial and oblique sagittal views of the
thoracic spine show the laminectomy defect from the level of T5 to T7, with an
expansile bone lesion in the right transverse process of the 6th thoracic
vertebra, and costotransverse segment of the 6th right posterior rib.
12
Correlating it with the histologic findings, this could be a residual
DISCUSSION
Sarcomas of the bone are rare and represent about 0.2% of all
new cancer cases each year. The two most common forms of bone
malignant tumors.4,5
occurs most frequently in the pelvis and femur (50%), and less
frequent in the ribs (15%) and spine (less than 7%). 7 It usually occurs
in the 5th and 6th decade of life with a male to female ratio of 1.5-2.0:
1.6 Our case belongs to the less than 7% of all chondrosarcomas (or
13
about 1.4% of the primary malignant osseous neoplasms), occurring in
reviews.
tumors may erode the cortex and invade the surrounding soft tissue.
patient’s case shows that the excised tumor could either be a primary
tumor of the transverse process of the 6th thoracic vertebra with soft
rib.
14
component have high water content due to hyaline cartilage. These
explains the MR imaging findings of the patient, wherein the low signal
mineralized component of the tumor and its water content, while the
the large soft tissue mass. Likewise, although the bony structures can
Hence, although most likely it was already there, its presence prior to
the operation could not really be ascertained and that CT scan could
surgical excision. The goal is total removal of the tumor with maximal
15
chemotherapy as well as radiation have very limited role since they
for high-grade types due to high metastatic tendencies 7,8. Our case is
Because of the rarity of this type of spinal tumor, only few cases
was also done which was negative. Surgery was then performed
year old man who experienced a 3 month history of back pain was
reported. 10
MRI was done and pre-operatively, the lesion was not
16
consideration of the intradural mass at that time was meningioma,
distribution. 13
RECOMMENDATION
17
imaging is primarily requested after x-ray of the spine, since it directly
image the spinal cord and extent of soft tissue involvement. However,
as in this case, not all paravertebral soft tissue masses that cause
spinal cord compression do readily signify a pure spinal cord lesion, but
it may also arise from the osseous and cartilaginous structures (e.g.
be done.
diagnosis.
18
And, specifically for this case, since the patient’s thoracic spine
CT scan revealed an expansile bone tumor in the spine and rib, biopsy
REFERENCES
19
3. Jallo, George I. Intradural Spine Tumors. Spine Universe.Com c
1999-2007.