PMC3551491_01
(a) Contrast sagittal image showing the L3 vertebral body collapse with a giant tumor component lying in retrospinal space. (b) Coronal contrast image showing extension of the tumor to both paraspinal spaces. (c) Axial contrast showing involvement of the L3 body with tumor coming out of the spinal canal through both side intervertebral foramina. Note there is no tumor at L4 intervertebral foramina. (d) T2 sagittal image
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F1
Magnetic resonance imaging (MRI) pictures showed a large mass lying in paraspinal and retrospinal region [Figure 1].
(a) Large extension of the tumor lying in subcutaneous plane. (b) Tumor specimen in piecemeal
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F2
The tumor was found to lie just beneath the skin [Figure 2a]. The tumor was reddish brown, fleshy, vascular [Figure 2b] with infiltration into the surrounding tissue.
(a) Densely cellular fascicles alternating with hypocellular myxoid zones (x200). (b) Spindle shaped cells in a vague storiform pattern (x200). (c) Cells have irregular contours with eosinophilic cytoplasm with wavy, buckled, comma-shaped nuclei (x400). (d) Cells showing pleomorphism, prominent nucleoli (x400). (e) Perivascular accentuation of tumor cells (x200). (f) Negative GFAP immunostaining. (g) Strong Ki-67 immunopositivity (x400)
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F3
Histopathology showed densely cellular fascicles alternate with hypocellular myxoid zones [Figure 3a]. The cellular areas showed large number of spindle cells arranged in a storiform pattern [Figure 3b]. Nuclei were wavy, buckled, comma shaped [Figure 3c] with prominent nucleoli [Figure 3d] suggestive of malignant variety of peripheral nerve sheath tumor. There were occasional areas of epithelioid differentiation and perivascular accentuation of tumor cells [Figure 3e]. Negative glial fibrillary acidic protein (GFAP) immunohistochemistry ruled out astroglial origin [Figure 3f]. Ki-67 proliferative index was 5.5%, suggestive of malignant nature of the tumor [Figure 3g].