PMC5379789_01
X-ray cervical spine showed osteolytic destruction of C2 body with subluxation of C1 and C2 complex over C3
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F1
X-ray of the cervical spine showed osteolytic destruction of the C2 body with subluxation of the C1 and C2 complex over C3 [Figure 1].
Magnetic resonance imaging cervical spine showed kyphosis of the cervical spine with destruction of C2 vertebral body along with posterior displacement of the severely compressed spinal cord
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F2
MRI also showed that the C2 vertebral body was showing T1 hypointense, T2 hyperintense lesions with posterior displacement of the severely compressed spinal cord [Figure 2].
X-ray showing occipito-C1-C3 lateral mass screws fixation with vertex Medtronic system
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F3
The patient underwent decompression of the C2 lesion through the C2 right pedicle with occipito-C1-C3 lateral mass screws fixation (vertex medtronic system) [Figure 3].
(a and b) Histopathological examination showed spindle cells arranged in whorls and fascicles with proliferation of smooth muscle cells surrounding the blood vessels. Spindle cells showed eosinophilic cytoplasm with elongated nuclei with blunt ends. There is moderate cellularity, minimal atypia, inconspicuous mitosis, and no evidence of necrosis; (c and d) Immunohistochemistry of the tumor cells stained positively for smooth muscle actin, and negative for S-100 protein
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F4
There was moderate cellularity, minimal atypia, inconspicuous mitosis and no evidence of necrosis [Figure 4a and b]. The tumor cells stained positively for smooth muscle actin, desmin and vimentin and negative for epithelial membrane antigen, S-100, Cluster of differentiation 34, estrogen and progesterone receptors, confirming the diagnosis of the leiomyoma [Figure 4c and d] and excluding the other possible lesions like meningioma and schwannoma.
Post operative magnetic resonance imaging at 1 year showed small residual tumor at C2 body
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F5
Postoperative MRI at 1 year showed residual tumor without cord compression [Figure 5], and she was asked for regular follow-up for any recurrence of symptoms.