PMC7661033_01
A-B. Plain lateral radiograph showing a vertebral fracture at C4.. C-D. Sagittal CT showing a vertebral fracture at C4 (A). Coronal CT of C4 showing destructive changes of the vertebra body, the right-side facet, and the right-side lamina (B).. E-G. Magnetic resonance images showing heterogenic low-intensity lesions at the C4 vertebra in T1- and T2-wighted images.
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Her plain radiographs showed a vertebral fracture at C4 (Fig. 1A, B). Her computed tomography (CT) showed destructive changes of the vertebral body, the right-side facet, and the right-side lamina at C4 (Fig. 1C, D). Her magnetic resonance images showed heterogenic low-intensity lesions at the C4 vertebra in T1- and T2-weighted images (Fig. 1E-G).
A-B. Lateral radiographs showing the progress of collapse at the C4 vertebral body and local kyphosis of 24 degrees between C3 and C5.. C-E. Postoperative radiographs (C) anteroposterior view (D) lateral view (E) postoperative T2-weighted sagittal MRI.
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The radiographs showed the progress of collapse at the C4 vertebral body and local kyphosis of 24 degrees between C3 and C5 (Fig. 2A, B). Therefore, we performed reconstruction surgery, i.e., subtotal corpectomy of C4; cage insertion (Phyramesh, Medtronic, Memphis, TN, USA) at C4; anterior plating (Zepher, Medtronic, Memphis, TN, USA) between C3 and C5; laminectomy of C3, C4, C5, and C6; and posterior fixation using cervical pedicle screw between C2 and C7 (Vertex MAX, Medtronic, Memphis, TN, USA) (Fig. 2C-E).
A-B. Scale bar in Figure 3A is equal to 250.00 um and in Figure 3B is equal to 25.00 um. Microscopic findings revealed that spindle cells were relatively fascicular in growth. Nuclear atypia was seen. A somewhat irregular cement line was seen in the trabecular bone, but it was relatively mature trabecula from trabecular arrays and substrate state. Additionally, invasion of malignant lesions into cancellous bone was observed.
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However, 1 month later, we finally obtained the diagnosis of post-radiation spindle cell sarcoma (Fig. 3A, B).
A-B. T2-weighted magnetic resonance imaging performed 3 months after surgery. The tumor was seen to extend cephalad, caudad, front, and back of the cervical spine.
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However, the tumor was continuously extended (Fig. 4A, B).