PMC8168697_01
Preoperative X-ray whole spine anteroposterior and lateral view showing osteolytic lesions in D8 and L3 vertebral bodies with erosion and collapse of D8 vertebra.
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F1
Of interest, lumbar X-rays and lumbar MR scan both demonstrated an additional although smaller, asymptomatic L3 vertebral body lesion [Figures 1 and 2].
Preoperative MRI sagittal and axial T1- and T2-weighted images showing collapsed D8 vertebral body with surrounding free fluid extending posteriorly from D7 to D9 vertebra and causing significant compression of spinal cord with a lesion in L3 vertebral body causing dural sac indentation.
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F2
Of interest, lumbar X-rays and lumbar MR scan both demonstrated an additional although smaller, asymptomatic L3 vertebral body lesion [Figures 1 and 2].
Postoperative X-ray postdecompression X-ray spine anteroposterior and lateral views showing pedicle screws inserted from D6 to D10 and L2-L4 vertebral levels sparing involved D8 vertebra.
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F3
The patient's progressive myelopathy prompted a T8, T9 laminectomy that included a culture/biopsy of the lesion, epidural debridement, and T6-T10 pedicle screw fixation [Figure 3].
Histopathological examination report showing inflammatory granulation tissue.
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F4
(a) PET-CT scan showed metabolically active osteolytic lesion predominantly in D8 vertebra and in multiple regions such as D7, D9, D11 vertebral bodies, left 7th rib, sternum, and right iliac bone along with bilateral pleural effusions, mediastinal, and left supraclavicular lymphadenopathy and soft-tissue lesions in the left orbit and left temporal region of brain. (b) Surgical site biopsy and its paraffin block with further biopsy from the left 7th rib and immunohistochemistry studies confirmed it to be extramedullary myeloid sarcoma.
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F5
Four weeks postoperatively, when he returned with dyspnea and cough, the PET-CT scan revealed a metabolically active osteolytic lesion predominantly involving the T8 vertebral body, with extension into the T7, T9, and T11 vertebral bodies, involving the left 7th rib, as well as multiple other sites [Figure 5a]. Biopsy of the left 7th rib and immunohistochemistry studies confirmed that the lesion was an EMS [Figure 5b].