PMC4258720_01
(a) Sagittal T1-weighted enhanced image showing heterogeneous enhancing epidural mass centered at L2. (b) Sagittal T2-weighted image illustrates compressive mass surrounding the cauda equina. (c) Axial T1-weighted enhanced image shows massive left retroperitoneal lesion extending into the L2 neural foramen and epidural space
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F1
Workup during the more recent visit revealed an L2 mass invading the spinal canal for which the patient was transferred to our facility for neurosurgical evaluation [Figure 1]. A magnetic resonance image (MRI) of the spinal axis demonstrated a 12 cm left-sided retroperitoneal mass that extended into the spinal canal at the L2 and L3 levels through the left L2 and L3 neural foramen with severe thecal sac compression at the L2 level [Figure 1].
Postoperative radiograph demonstrating the fusion construct for stabilization spanning T12-L4
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F2
As the amount of bone and tumor removed was likely destabilizing and the bone quality found to be poor at these levels, a posterolateral pedicle screw fusion was performed from T12 through L4 [Figure 2].
Hematoxylin and eosin pathologic stain of epidural tumor. (a) Low-power view showing diffuse hemorrhages common in choriocarcinoma. (b) High-power view highlighting syncytiotrophoblasts and large, pleomorphic malignant single cells
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F3
Final histopathologic analyses revealed abundant tissue necrosis with an estimated live tumor cell presence of only 5-10% [Figure 3].