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case_images: a. Lumbar X-ray (lateral view), showing lytic lesion in second lumbar vertebra (red arrows). b. Lumbar MRI, sagittal view, showing tumor in second lumbar vertebra (red circle) causing cord compression (blue arrows). c. Abdominopelvic CT scan showing vertebral mass (yellow circles) without any kidney tumor. d. Coronal reconstruction of abdominopelvic MRI, showing tumor in vertebra (green circle) and normal kidneys (white arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: Plain lumbar X ray was taken showing a suspected lytic lesion in the body of second lumbar (L2) vertebra (Fig. 1 a). Lumbar MRI revealed 4.5 cm mass in the body and pedicle of L2 expanding posterior cortex into spinal canal (Fig. 1 b). IV contrast was taken exhibiting no sign of renal tumor nor lymphadenopathy but the same mass in L2 (Fig. 1 c). In order to complete metastasis workup, chest and brain CT was taken which showed no abnormality. As abdominopelvic MRI results were similar to the findings of CT scan (Fig. 1 d), corpectomy and pedicle resection along with tumor removal were performed (Fig. 2 a, b).
case_images: a. L2 vertebral cortex after corpectomy and resection of tumor through flank incision. Blue arrows indicate corpectomy site. b. Yankauer suction placed into resection site of the tumor showing depth of resection. c. Insertion of screw-rod system into first and third lumbar vertebra. White arrow shows site of tumor resection. d. Post-operation lumbar X ray (anteroposterior view), showing mesh cage and the screw-rod system. e. Lateral view of post-operation lumbar X ray. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: The L2 vertebra was reconstructed by mesh cage filled with allogenic bone and the screw-rod system was inserted into first and third lumbar vertebra through both anterior and posterior approaches (Fig. 2 c, d, e).
case_images: Hematoxylin and eosin stain of the resected mass showing tumor cells with clear cytoplasm and oval nuclei. a. x40 b. x100 c. x400.
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case_images: Pathology was clear cell RCC, same as biopsy (Fig. 3).
case_images: Follow up CT scan 3 months after surgery revealing no tumor progression nor any kidney tumor. Yellow arrows show screw-rod system and green arrows show normal kidneys. a. Transverse section b. Coronal reconstruction of CT scan. Thin yellow line indicates the location of transverse section. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: Follow up CT scan 3 months after surgery showed no sign of renal tumor or disease progression (Fig. 4).