PMC8202395_01
(a) Interpedicular and interspinous widening at C5, implementing large expansile lytic lesion replacing C5 vertebral body. Left C5 pedicle absent while right C5 pedicle displaced and thinned out. (b and c) Sagittal cervical spine magnetic resonance imaging showing soft-tissue mass isointense on T1 and T2, replacing C5 body, with T2 hyperintense cavity in the anterior part. (d) Axial section at C5 level, showing homogeneous enhancement of lesion, extension to the left pedicle, and thecal sac compression. Posterior elements are well spared
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F1
Plain X-ray cervical spine on anterior-posterior (AP) view showed a large lucent lesion replacing the C5 vertebra with loss of the left pedicle [Figure 1a]. The lesion enhanced homogeneously with gadolinium and appeared completely extradural [Figure 1b-d].
(a) Biopsy specimen as yellow soft-to-firm mass removed piecemeal. (b) Histological findings (hematoxylin and eosin stain): Numerous foamy cells, cholesterol clefts, and multinucleated giant cells. (c) Immunohistochemical findings (streptavidin-biotin-peroxidase method): Cells showed strong positivity for CD68
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F2
T2 hyperintensity. The lesion was excised in piecemeal fashion [Figure 2a] to completely decompress the cord. CD68 was positive and S100 was found to be negative [Figure 2b and c].
(a) Postoperative X-ray cervical spine, anterior-posterior view. (b) Lateral view, due to very short neck, lower screws are not visible
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F3
Postoperative imaging as per routine following anterior decompression and fixation consisted of plain X-ray cervical spine AP and lateral views [Figure 3a and b].