PMC4408628_01
Sagittal (a) and frontal (b) CT showing osteolytic bone lesions in S1, sized 2.9*2.1*2.2 cm. (c) Frontal X-rays of lumbosacral region of spine, showing spinal fusion with titanic block.
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It was recorded that the patient's ailments, at the time of presentation, had commenced at the age of 23 years, and 3 years later the osteolytic bone lesions in S1 and L5 vertebrae were found on MRI and CT scans (Figures 1(a) and 1(b)). S1 vertebral body and spinal fusion with titanic block (Figure 1(c)). Six months later, due to the progression in thoracic vertebrae, the tunnel resection and radiothermoablation of Th4 and Th7 were performed.
(a) Hematoxylin-eosin staining, x100. (b) High-power view of hematoxylin-eosin staining, x400. Arrows: groups of xanthoma cells, arrowhead: giant multinuclear cell, stars: foci of fibrosis.
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Postoperative material was prepared for histological investigation and subsequent analysis revealed the foci of fibrosis, within which there were groups of xanthoma cells and multinuclear giant cells (Figures 2(a) and 2(b)); the Reed-Sternberg cells were not detected.
Immunohistochemistry. (a) Staining for CD68, x200. Prominent expression of CD68 in xanthoma and giant multinuclear cells. (b) Staining for S-100, x400. Less than 5% of the xanthoma cells express S-100. (c) Staining for FXIIIa, x400. 10-15% xanthoma cells have nuclear-cytoplasmic expression of FXIIIa.
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These cells stained positively for CD68 (Figure 3(a)), but not CD1a. S100 positive (Figure 3(b)), and 10-15% were positive for factor XIIIa (Figure 3(c)). Such an immunophenotype suggested that ECD was a plausible explanation for the reported symptoms, and the relapse of Hodgkin disease could be excluded as atypical cells with CD30 and CD15 expression were not detected.