PMC10159241_01
Preoperative computed tomography (CT) image and magnetic resonance imaging
(MRI) showing mass lesion at T1. (A) An axial CT image showing a massive
destructive bone lesion from the T1 vertebra to the right pedicle. (B and C)
A sagittal T1-weighted MRI (B) and an axial T2-weighted MRI (C) showing
epidural spinal cord compression by a progressive tumor (indicated by white
arrows) with complete obliteration of the cerebrospinal fluid space at the
affected level.
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Magnetic resonance imaging (MRI) showed epidural spinal cord compression with complete obliteration of the cerebrospinal fluid space at the affected level caused by a progressive tumor (Figure 1A and B).
Hematoxylin and Eosin staining microphotographs showing spindle cells with
polymorphic atypical nuclei and osteoid of an osteosarcoma with low
magnification (x40) (A) and high magnification (x100) (B).
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Hematoxylin and Eosin staining sections demonstrated spindle cells with polymorphic atypical nuclei and osteoid (Figure 2A and B).
An intraoperative photograph after laminectomy at the level of the epidural
tumor extension and at least partially above and below the levels of the
tumor indicating circumferential decompression of the spinal cord.
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We removed the region of the tumor that surrounded the epidural spinal cord with no attempt to aggressively remove the residual tumor and achieved circumferential decompression with more than 3 mm of tumor-free interval (Figure 3).
Postoperative images of the cervicothoracic spine with posterior
instrumentation between C5 and T4 and circumferential decompression at T1
level. (A and B) A posteroanterior radiograph (A) and a lateral radiograph
showing posterior instrumentation from C5 to T4. (C and D) Axial images of
computed tomography (C) and T2-weighted magnetic resonance image (MRI)
showing sufficient circumferential decompression of the spinal cord.
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Postoperative MRI showed that the epidural tumor was resected circumferentially from the epidural spinal cord, and epidural spinal cord decompression was accomplished (Figure 4A-C).
The intensity-modulated radiation plan showing satisfactory prescribed tumor
target coverage and excellent sparing of the spinal cord.
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Two weeks after separation surgery, IMRT at a total dose of 70 Gy was performed (Figure 5) without any irradiation-induced side effects and 4 cycles of doxorubicin and cisplatin were performed as adjuvant chemotherapy.
A sagittal (A) and an axial (B) T2-weighted magnetic resonance image (MRI) at
the 5-year follow-up showing no local recurrence.
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At 5-year follow-up, the patient was alive without local recurrence (Figure 6).