PMC6481151_01
MR of the lumbar spine. (a) T2-weighted sagittal Spectral Attenuated Inversion Recovery (SPAIR) image. (b) T1-weighted axial image. (c) T2-weighted axial image. There is a T1-hypointense, T2-heterogeneous soft tissue mass occupying and destroying a large part of L4, causing nerve root compression.
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The exam revealed the presence of a heterogeneous, T1-hypointense mass in the body of L4, causing its partial destruction, and nerve root compression (Figure 1).
Chest CT, axial image. There is a soft tissue density mass measuring 44 mm and an 8 mm nodule, both in the left lung.
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Subsequently, a contrast-enhanced CT was performed to evaluate if other organs were affected: there were several soft tissue density round masses in the thorax, the largest being located in the left lung, measuring 44 mm (Figure 2).
Contrast-enhanced CT. Axial view. There is a heterogeneous enhancing mass destroying the left iliac bone and expanding both in and out of the pelvic cavity. The iliac vessels have deviated towards the right. No evident infiltration of pelvic structures was observed.
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This mass had a lytic component and exhibited an intrapelvic bulky element (Figure 3).
Contrast-enhanced CT. Sagittal view. There is a lytic lesion occupying the L4 vertebral body displaying a soft tissue component. The uterus is enlarged and depicts a nodular and lobulated contour, due to the presence of several leiomyomas.
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There was enlargement of the uterus due to the presence of several leiomyomas (Figure 4).
CT. Sagittal view. Pedicle screw fixation of L3-L5 after subtotal tumorectomy.
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The clinical conduct included vertebral subtotal tumor removal, laminectomy, and pedicle screw fixation on L3-L5 (Figure 5) to decompress the nerve roots and reduce the symptoms.