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MR imaging of the spine of the patient at initial diagnosis. (A) Sagittal T2-weighted MR image revealed a burst fracture with spinal canal involvement at the thoracic T2 level (arrow). (B) Axial T2-weighted MR image identified a tumor in the anterior, para- and retro-vertebral regions, associated with epidural invasion. MR, magnetic resonance.
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T2 and a soft tissue mass with epidural invasion and central spinal stenosis (Fig. 1A). The soft tissue lesion was visible around the anterior-, para- and retro-vertebral regions (Fig. 1B).
Computed tomography axial images of the brain 19 months subsequent to initial diagnosis. (A) Marked dilatation of the ventricles and transependymal cerebrospinal fluid resorption at the level of the lateral ventricle. (B) Dilation of the fourth ventricle (arrow). These findings indicate obstruction below the ventricular system.
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Brain CT indicated marked dilatation of the ventricles, suggesting hydrocephalus (Fig. 2A). Marked dilatation of the ventricles, including the fourth ventricle, with transependymal CSF resorption, which is consistent with hydrocephalus, was observed (Fig. 2B).
MR studies of the spine 19 months subsequent to initial diagnosis. (A) Sagittal T2-weighted MR image demonstrated progressive change in tumor size (arrow) and the formation of syringomyelia (double arrow). (B) Axial T2-weighted MR image displayed a flattened spinal cord compromised by the enlarging tumor (arrow). MR, magnetic resonance.
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In order to confirm this hypothesis, MR imaging of the thoracic spine, with and without contrast enhancement, was performed (Fig. 3A and B).
Histological examination of the tumor demonstrated numerous osteoclast-like multinucleated giant cells mixed with mononuclear ovoid stromal cells, consistent with a giant cell tumor (hematoxylin and eosin; magnification x100).
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Macroscopically, the tissue was a soft, brown mass; microscopically, it was observed to contain numerous osteoclast-like multinucleated giant cells (that were evenly distributed) mixed with mononuclear ovoid stromal cells (Fig. 4).
Mid-sagittal T2-weighted magnetic resonance image of the spine 30 months following initial surgery demonstrated syringomyelia (arrows) and stable tumor size.
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The results demonstrated that the size of the tumor was stable (Fig. 5), which is compatible with the slow growth characteristic of GCTs.