PMC4845402_01
Preoperative Xray
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F1
Radiographs showed scoliotic deformity at upper dorsal spine and soft tissue enhancement in the right mediastinal region at the D6, D7, and D8 region in the anteroposterior view (Fig. 1). Kyphotic deformity noted at the upper dorsal spine and reduction of disc space at D7-D8 and D8-D9 level (Fig. 1).
CT scan.
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F2
Computed Tomography (CT) confirmed the presence of the lesion, which showed soft tissue density (Figs. 2, 3).
CT scan done during CT guided biopsy.
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F3
Computed Tomography (CT) confirmed the presence of the lesion, which showed soft tissue density (Figs. 2, 3).
MRI showing the tumor compressing the cord.
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F4
On Magnetic Resonance Imaging (MRI), the lesion showed intermediate signal intensity on T1 sequences, while on T2 sequences a high signal center and an intermediate signal periphery were observed (Figs. 4, 5).
MRI showing the tumor arising from the D7, D8, D9 vertebral levels.
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F5
On Magnetic Resonance Imaging (MRI), the lesion showed intermediate signal intensity on T1 sequences, while on T2 sequences a high signal center and an intermediate signal periphery were observed (Figs. 4, 5).
Intraoperative image showing a friable tumor mass compressing the cord.
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F6
Intraoperatively, we found a large friable tumor mass which was adherant to the pleura of the right lung arising from the D7, D8, D9 costovertebral junction compressing the spinal cord (Fig. 6).
Excised tumor mass.
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F7
Using a right transthoracic (single staged combined anterior and posterior) approach, en bloc tumor resection (Fig. 7) of size (5cm x 5cm) with partial excision of the affected 7th, 8th and 9th rib was done followed by stabilization with heartshield cage and sublaminar wires (Fig. 8).
Histopathological slide showing polygonal stromal cells, osteoclastic giant cells and many hemosiderin laden macrophages on high power view.
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F9
Intraoperatively samples of the tumor mass with the affected ribs were sent for histopathological examination which showed polygonal stromal cells, osteoclastic giant cells and many hemosiderin laden macrophages on high power view (Fig. 9).