PMC8645467_01
Anteroposterior (a) and Lateral (b) radiographsshowinglyticexpansilelesion in thepoosteriorelemnts of C3 spinous process with cervical spine in mild kyphosis. Computer tomography images Sagittal (c), Coronal (d) andAxial images (e) showing lytic expansile lesion involving C3 vertebral body and posterior elements more onto the left side.
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F1
The X-rays and CT scan revealed a destructive lytic C2-C4 lesion focused at the C3 level vertebral body (i.e. destructive lytic lesion of anterior/posterior C3, the C2 spinous process, and anterior C4 vertebral body) [Figure 1].
Sagittal section of STIR (a), T2 weighted (b) and T1 weighted (c) images showing high signal intensity on Stir images in C3 vertebral body and posterior elements and hypointense signal on T1 weighted images. Cord compression due to epidural mass effect can be appreciated from posterior aspect. (d) Axial T2 weighted images at C3 vertebral body level showing destruction of Spinous process and left sided lamina and lateral mass with epidural tissue compressing and displacing the spinal cord.
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F2
T2 weighted images and hyperintense to cord on the T2-weighted image [Figure 2] The PET CT confirmed increase uptake at C3 alone [Figure 3]. The predominant differential diagnoses included lymphoma or metastatic tumors or infection.
PET-CT scan images showing solitary lesion involving the C3 vertebral body with destruction of posterior and anterior bony elements with hot spots noted in C3 body, spinous process, lamina and lateral mass more towards the left.
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F3
T2 weighted images and hyperintense to cord on the T2-weighted image [Figure 2] The PET CT confirmed increase uptake at C3 alone [Figure 3]. The predominant differential diagnoses included lymphoma or metastatic tumors or infection.
Anteroposterior and lateral radiographs in the immediate post-operative period showing resection of posterior elements and laminectomy at C3 and fixation with a novel three rod construct utilizing C2 and C4 (left) pedicle screws and C2 laminar screw with C4, C5 lateral mass screws.
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F4
A novel "three rod construct" fusion was performed that included C2 pedicle screws, laminar screws, a C4 left pedicle screw with lateral mass fixation of C4 and C5 [Figure 4].
Haematoxylin and Eosin photomicrographs demonstrating (a) a germinal centre with hyaline deposits and penetrated by sclerotic blood vessels and typical concentric rings of small lymphocytes in an onion skin composition. (b) Dense lymphoid infiltrate with hyperplastic lymphoid follicles with small, hyalinised germinal centres, mantle cell hyperplasia. (c) Low power view of the tissue showing vascular and lymphoid proliferation hyalinised blood vessels penetrating radially into the follicles.
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F5
Histopathology was consistent with a lymphoproliferative disorder (i.e. with follicles of different size with abnormal germinal structures at their centres with hyaline-vascular or "burnt-out" appearances) [Figure 5].
Follow-up T2 weighted (a) and T1 weighted (b) sagittal MR images showing adequate decompression of cord and axial MRI (c) showing adequate resolution of tumour. Coronal (d) and sagittal (e) images showing resolution of tumorous mass and lateral (f) and anteroposterior (g) radiographs showing no signs of implant failure.
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F6