PMC3524240_01
Plain radiographs of the lumbar spine, (A and B) preoperative and (C and D) 6 months postoperative.
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An X-ray revealed that the lesion was limited to the left lateral mass of the atlas, causing a potential instability (Fig. 1A and B). There was no recurrence and no other complaints over a 6-month follow-up period (Fig. 1C and D).
An osteolytic vertebral fracture in the right lateral mass of the L4 and accessories, accompanied by (A) a paravertebral and (B) intraspinal soft tissue mass. The mass (C) significantly decreased 5 days after PVP and (D, arrow) disappeared completely after 3 chemotherapy cycles. Computed tomography (CT) showed the distribution of bone cement in the osteolytic lesion of the L4 with minimal right lateral cement leakage. L4, fourth lower lumbar vertebra; PVP, percutaneous vertebroplasty.
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Computed tomography (CT) revealed an osteolytic lesion in the right lateral mass of the L4 and accessories, accompanied by a paravertebral and intraspinal soft tissue extension (Fig. 2A and B). The spread of the cement was ideal with the exception of a small amount of paravertebral leakage of cement (Fig. 2C) which did not cause any symptoms. Notably, CT revealed a significant decrease in the paravertebral and intraspinal soft tissue extension 5 days after the PVP (Fig. 2C). CT revealed that the paravertebral and intraspinal soft tissue extension disappeared after 3 cycles (Fig. 2D).
MRI, sagittal section. Hypointensity on T1-W images of L4 planar appearance with a mild compression fracture. T2-W images reveal more marked hypersignals of the body of L4 associated with the recent collapse. MRI, magnetic resonance imaging; L4, fourth lower lumbar vertebra, T1 W, T1 weighted; T2 W, T2-weighted.
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Magnetic resonance imaging (MRI) revealed osteolytic destruction of the vertebral body associated with a mild compression fracture that exhibited hypointensity on T1-weighted (T1-W) images and hyperintensity on T2-weighted (T2-W) images (Fig. 3).
High-power photomicrograph shows Langerhans' histiocytes and mixed numerous eosinophils. Neoplastic cells showing abundant eosinophilic cytoplasm, round to oval vesicular nuclei, and distinct nucleoli.
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Immunohistochemical staining was positive for CD1a and S-100 (Fig. 4).
Radiography during PVP of the L4. Right posterolateral approach. Injection of polymethylacrylate and penetration of the L4. Images show cement filling at the right side of the vertebral body. PVP, percutaneous vertebroplasty; L4, fourth lower lumbar vertebra.
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The patient underwent PVP (Stryker, Inc., Meyzieu, France) under local anesthesia in the prone position with the belly suspended in midair, under C-arm imaging guidance (Fig. 5).