PMC4483782_01
CT scans (a and b) obtained just before the operation showed an amorphous, expansible, multilobulated and calcified mass in the posterior element of C3 and C4, with encroachment into the spinal canal
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F1
A computed tomography (CT) scan of the cervical spine [Figure 1] demonstrated an amorphous calcified mass posterior to the spinous process that extended into the interlaminar spaces of C3/4 and C4/5 with encroachment into the spinal canal.
CT scans obtained 4 years prior to the current admission to evaluate neck pain (a and b). Subtle calcification of the yellow ligament was observed at the C3/4 and C4/5 levels
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F2
Interestingly, a CT scan performed 4 years previously [Figure 2] to evaluate neck pain had demonstrated subtle calcification of a yellow ligament at C3/4 and C4/5; however, neither calcified masses nor bone erosion were observed.
MRI performed prior to the operation showing a large low-intensity mass on both T1- and T2-WI, suggesting the mass to be calcified
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F3
On magnetic resonance (MR) imaging performed on the current admission [Figure 3], the mass exhibited hypointensity on both T1- and T2-images.
Photomicrographs of the lesion (a) hematoxylin-eosin stain, (b) von Kossa stain and (c) immunohistochemical staining revealing amorphous calcified deposits with CD68-positive macrophages, suggesting a foreign body reaction. These findings were consistent with tumoral calcinosis
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F4
Pathological examinations [Figure 4] showed amorphous calcified deposits (A: Hematoxylin and eosin stain, and B: Von Kossa stain) with CD68-positive macrophages (C: Immunohistochemical staining), suggesting a foreign body reaction.
Postoperative CT scans at the C3/4 level. (a) Three days after the operation, residual calcified masses were observed posterior to the lamina of C4. (b) Seven months after the operation, new bone had formed in the involved lamina and facet of C4
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F5
CT scan showed some of the small calcified masses to be residual [Figure 5a]. CT performed 7 months after the surgery demonstrated the disappearance of the residual small calcified masses with new bone formation in the involved lamina or facet of C4 [Figure 5b].