PMC6370146_01
(A-H) Preoperative transverse computed tomography showing the primary thymic carcinoma in the anterior mediastinum.
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F1
Upon further questioning, he recalled a history of thymic carcinoma (Fig. 1A-H).
(A-D) Preoperative sagittal MRI scan revealing abnormal signal of T4 in keeping with diffuse metastatic infiltration caused by metastatic thymic carcinoma. MRI = magnetic resonance imaging.
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F2
T4 mass, with increased metastatic marrow infiltration of the left T4 vertebral body, which presented as a solid tumor (Fig. 2A-D). Tumor infiltrated through the T4 vertebral body into the left pedicle and posterior elements.
(A-G) Preoperative coronal and transverse MRI images revealing spinal cord compression secondary to the epidural component of the T4 mass, with increased metastatic marrow infiltration of the left T4 vetebral body, which presented as a solid tumor. Tumor infiltrated through the T4 vetebral body into the left pedicle and posterior elements causing significant compression of the nerve root. MRI = magnetic resonance imaging.
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F3
Extraosseous spread into the left lateral aspect of the epidural space extending posteriorly, resulting cord compression with the nerve root (Fig. 3A-G).
(A) PA X-ray image of the thoracic spine obtained postoperatively. (B) Lateral X-ray image of the thoracic spine obtained postoperatively. PA = posteroanterior.
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F4
An X-ray after the surgery confirmed the correct positioning of the implants and no signs of displacement of the screws and rods (Fig. 4A and B).
Pathologic histology of spinal metastases. (A-C) Microphotography showing characteristic nests of tumor cells separated by vascular septa (Zellballen) with cells showing significant nuclear pleomorphism with prominent nucleoli (H&E, original magnification 100x, 200x, and 200x). (D) AE1/AE3 immunostaining is strongly positive in the epithelial cells. (E) CD5 immunostaining shows strong, diffuse cytoplasmic staining in the tumor cells. (F) The sustentacular cells of the spinal metastases of TC showing characteristic staining of P63.
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F5
Biopsy samples were positive for CD5, P40, P63 (Fig. 5A-F).