PMC3745896_01
Axial T1 weighted postcontrast computed tomographic images show a large mid-thoracic spine mass (a) before and (b) 10 months after denosumab therapy.
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Follow-up computed tomographic imaging in May 2010 demonstrated an increase in the size of the mass from 9 x 8.9 cm AP to 10.2 x 9.2 cm (Figures 1(a) and 2(a)). By May 2011, the tumor had shrunk to 1.9 x 5.4 cm (Figures 1(b) and 2(b)).
Representative photomicrographs of the paraspinal mass after denosumab therapy. At low magnification ((a); 100x, hematoxylin and eosin), extensive necrosis is apparent with abundant cholesterol clefts (center) and surrounding fibrosis (top). Residual tumor is focally recognizable but is entirely necrotic (lower left), and no viable tumor is present. At high power ((b); 400x, hematoxylin and eosin), "ghosts" of necrotic multinucleated osteoclastic giant cells are present among necrotic mononuclear tumor cells.
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Postoperative pathology showed a complete chemotherapeutic response, with extensive necrosis and fibrosis throughout the entire specimen and only focally recognizable tumor remaining, all of which was necrotic (Figures 3(a) and 3(b)).
Sagittal T1 (a) and T2 (b) weighted images show postsurgical changes with no significant residual tumor 7 months after resection.
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She remained free of recurrence, and an MRI done in April 2012 showed only postsurgical changes with no evidence of disease recurrence (Figures 4(a) and 4(b)).