PMC4782539_01
MRI cervical spine (coronal section) shows spinal cord swelling on (a) T1 and (b) T2 short tau inversion recovery (STIR) and (c) T2 STIR shows hyperintense lesion in the left lung apex. Figure d shows enhancement of multiple nerve radicles on T2 STIR coronal MRI. Figure e shows spinal cord swelling on T2 sagittal image extending from C3-C7 and (f) parasagittal T1 fat suppression with contrast image shows contrast enhancing irregular mass in the left lung apex
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F1
In addition, hyperintensities of multiple radicles were noted bilaterally on T2 fat suppression images [Figure 1]. Incidentally, MRI revealed an ill defined, heterogeneously enhancing lesion (4 x 3 x 3 cm3) in the left upper lung [Figure 1].
Follow up imaging after 2 months shows (a) resolution of hyperintensity in cervical cord on sagittal T2 weighted MRI. However, the lung mass was clearly evident and increased in size on, (b) coronal T2 short tau inversion recovery (STIR) and (c) T1 fat suppression. (d) STIR coronal view shows resolution of signal changes in the nerve roots. Figures e and f shows contrast enhancing rounded opacity in the apex of left lung on computed tomography of chest
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F2
Computed tomography (CT) thorax showed well defined heterogeneously enhancing soft tissue attenuation lesion with speculated margin in apico posterior segment of left upper lobe [Figure 2]. MRI cervical spine [Figure 2] done after one month of steroid therapy showed disappearance of the cord hyperintensity but the mass lesion had increased significantly in the size (6 x 4 x 6 cm3).
The tumor cells are pleomorphic, round to oval in shape having high nucleo cytoplasmic ratio, hyperchromatic nuclei inconspicuous nucleoli surrounded by moderate to abundant cytoplasm suggestive of squamous cell carcinoma
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F3
CT guided fine needle aspiration cytology revealed malignant epithelial cells lying in clusters in a hemorrhagic background [Figure 3].