PMC9638719_01
Extramedullary hematopoiesis in the spinal canal with compression of the spinal cord and the terminal filium. Sagittal view injected CT scan (left) and MRI STIR sequence before RT (middle) and three months after RT (right).
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A CT scan and MRI revealed bilateral paravertebral masses staggered along the spine from T2 to S1, suggesting extramedullary hematopoietic lesions with a hyperintense mass on T2 and isointense with peripheral enhancement on T1 (Fig. 1). MRI showed a very significant decrease in paravertebral masses and in the thoracic spinal canal, with the total disappearance of the lumbosacral masses and the development of small lesions in the T2 hypersignal osteomedullary lesions of the thoracolumbar spine and sacrum that were both asymptomatic and non-specific. (Fig. 1, middle and right). MRI confirmed complete response at 6 months.
Radiation therapy planning. Isodose distribution in color wash, scale above.
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We prescribed 18 Gy in 10 fractions of 1.8 Gy, five days per week, using helical Tomotherapy (6 MV photon beams). (Fig. 2).