PMC4799347_01
Radiograph of the lumbar spine without evidence of the tumor at L4: anteroposterior view (A) and lateral view (B).
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The initial radiographs on the lumbar spine did not show bone lesions (Figure 1).
Computed tomography of the lumbar spine, showing osteolytic lesion at L4, in sagittal slice (A). Axial slices: showing the destruction in a slice for bone (B) and tumor invasion of the canal in a slice for soft tissues (C).
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This was seen to be invading the medullary canal and neural foramens and compromising the nerve roots, especially on the left side (Figure 2).
Nuclear magnetic resonance imaging on the lumbar column, in a sagittal slice showing hyposignal in T1 (A) and hypersignal in T2 (B).
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Nuclear magnetic resonance showed that the bone structure of the L4 body had been replaced by tissue presenting hyposignal in T1 and hypersignal in T2, with strong highlighting after introducing gadolinium, accompanied by invasion and compression of the medullary canal, without changes to the soft tissues (Figure 3).
Percutaneous biopsy using needle guided by computed tomography, in axial slice.
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A tomography-guided biopsy was then performed, from which an initial diagnosis of high-grade sarcomatous pleomorphic neoplasia was made (Figure 4).
Postoperative radiographs on lumbar spine showing resection of the L4 vertebral body and anterior arthrodesis with a titanium cage, in anteroposterior view (A), and medullary decompression and posterior arthrodesis with pedicled screws, in lateral view (B).
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Lesion showing high cellularity and cell atypia, compatible with fusocellular sarcoma, corresponding to the undifferentiated area (hematoxylin-eosin: 100x).
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Immunohistochemical analysis was then performed with the following results: vimentin +, ENE +, CD31 -, CD34 -, JJF35 - (these last three were CI +), AE1 -, AE3 -, EMA -, S100 - and desmin -, thus confirming the diagnosis of primary liposarcoma of bone (Figure 6).