PMC10088559_01
Preoperative MRI scan of the patient's thoracic spine (A-C). Sagittal scan revealed the density of obvious bone destruction in the T8 on T1 and T2-weighted images (A, B). Transverse MRI scan showed a 6.5cm x 2.0cm sized and well-defined lesion occupying the T8 vertebral body, pedicle and lamina (C).
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The MRI showed a giant destructive soft tissue lesion occupying the T8 vertebral region with moderate destruction of the pedicle and lamina ( Figures 1A, B ). Another lesion was found on the seventh left rib ( Figure 1C ).
Preoperative transverse CT scan (A, B) showed the tumor occupied the 8th thoracic vertebral body and 7th rib.
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The preoperative medical tests, including an electrocardiogram and chest CT scan ( Figure 2 ).
Preoperative angiography of the 7th and 8th thoracic vertebral segment arteries showed that the tumor had a rich blood supply, and embolization was performed.
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Preoperative angiography showed abundant blood supply in the tumor ( Figure 3 ).
En-bloc excision tumor specimen in T8 and part of 7th rib of the patient and corresponding perspective image (A, B). Both images showed the integrity of tumor and the lesion was completely removed.
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During costectomy, a mass measuring 4.5 x 11 cm could be recognized, and no implant nodules, hydrothorax, or visible abnormality in the lungs were found around the 7th rib ( Figure 4A ). The left 8th vertebral body was exposed, and a giant tumor invading the vertebral body and the costovertebral joint was resected ( Figure 4B ).
Histopathology of the resected mass. High-power magnification (200x) shows cords and groups of epithelioid cells in a dense without well-formed vascular structures.
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Microscopic examination revealed that mostly eosinophilic endothelial cells constituted the tumor, without any well-formed vessels ( Figure 5 ).
Immunohistochemical stain of the resected mass. (A, B) Tumor cells expressed CD31 (A) and FIL-1 (B). Both immunohistochemical stain were in 100xmagnification.
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CD31, and CD34 expression. Combined CD31 and FLI-1 staining suggested the diagnosis of EHE ( Figure 6 ).
3 months follow-up after the surgery, x-ray display of thoracic spine showing transpedicular screw and a titanium mesh were used in the reconstruction of the stability of the spine in patient. (A: orthotopic position, B: side position).
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During a recent postoperative follow-up after the surgery, there was no indication of any tumor progression or the emergence of any new symptoms ( Figure 7 ).