PMC5267914_01
MRI images of the spine in sagittal T1 (a&b), sagital T2 (c) and post contrast sagital (d) and axial (e). The tumor is hypointense to bone on T1 weighted images (a&b), slightly hyperintense and heterogeneous on T2 weighted images (c), with intense, irregular contrast enhancement (d&e). Note the vertebral body involvement in T5 lesion (superior arrows in a, b & c). Note the severe spinal cord compression (middle arrows in a, b, c & e). Note the contrast enhancement along the dura that extends upward and downward (upper arrow in d). Image "f" is an axial CT scan slide showing the sacral lesion with the bone lysis (arrow).
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Findings were compatible with multiple metastases, and involved: (Figure 1) the posterior part of the vertebral body of T5, with posterior wall rupture (Figure 1 b); the posterior elements of T12 and L1 vertebras, with a tissular mass causing bone lysis, severe cord compression and extending to the paravertebral region; the vertebral body was intact (Figure 1 a, b, c, d, and e). Vertebral body of S1, with lysis, right spinal canal invasion and extension to the pre-vertebral area (Figure 1 f) These lesions were iso- to hypo-intense to bone on T1 weighted images (Figure 1 a, b), and heterogeneous on T2 weighted images with multiple hyperintense foci (Figure 1 c). Contrast enhancement was intense and also heterogeneous, and was extending vertically along the epidural space of the medial lesion (Figure 1 d).
Operative findings. The tumor caused extended bone lysis (arrows in a); the dura was not invaded. The tumor was white-reddish and multilobulated (b)
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The dura matter was not infiltrated (Figure 2).
Photomicrograph of the biopsy specimen showing interlacing fascicles of spindle-shaped cells with elongated or blunt-ended nuclei and eosinophilic cytoplasm. Hyperchromatic or pleomorphic nuclei and mitoses are occasionally observed. (Haematoxylin and eosin; Original magnification, x100)
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Tumor cells were arranged into short fascicles and interlacing bundles (Figure 3).
Immunohistochemistry staining: the tumor cells are positive for H-Caldesmon (a), Alpha-Smooth Muscle Actin (b), Desmin (c), negative for S100 (d), (Original magnification, x100)
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Immunohistochemical staining was positive for smooth muscle actin, desmin and H-caldesmon, and negative for S100 protein, and CD34 (Figure 4).
Axial CT scan slide, showing the metastatic frontal bone lytic lesion (arrow)
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CT scan was performed, showing a small lytic frontal bone lesion extending to the subcutaneous tissue without dural extension (Figure 5).