case_images: PMC9935967_01
case_images: Extrapleural malignant solitary fibrous tumor of the pleura in a 88-year-old male patient who presented with back pain and had a history of pneumonectomy due to pulmonary tuberculosis.. A. Axial (left) and coronal (right) contrast-enhancing chest CT scans demonstrate infiltrative bilateral paravertebral enhancing masses at T6-7 levels (white arrows) with extension into the central spinal canal. However, there is no neural foraminal widening (black arrows). Bony erosion is seen at the costovertebral junction of the left 6th rib (arrowhead). Left pneumonectomy status is noted with a large expansile fluid collection in the left hemithorax and partially calcified uneven pleural thickening.. B. Axial T1-weighted MR image (left) and T2-weighted MR image (right) display diffuse T1 low and T2 heterogeneous high signal intensity space occupying lesions in both paravertebral aspects at the T6 level (white arrows) with direct invasion into the epidural space of the spinal canal. There is no definite evidence of bony cortical destruction or widening of the neural foramen at the T6 level (black arrows). Combined bone marrow signal intensity changes of the T6 vertebral body and the left posterior arc of the 6th rib are noted (arrowheads).. C. The paravertebral masses show intense FDG uptake on fluorine-18-FDG PET/CT.. D. CT-guided coaxial needle biopsy was performed for the left paravertebral mass at the T6 level.. E. Microscopic findings show hypercellular proliferation of spindle cells with "staghorn" vascular spaces (left, H&E stain, x 100). Significant pleomorphism and atypical mitosis can be noted (arrow) (right, H&E stain, x 200).. F. Immunohistochemistry shows positive staining for CD99 (left, x 200) and negative for CD34 (right, x 200).. FDG = fluorine deoxyglucose, H&E = hematoxylin & eosin
case_images: jksr-84-304-g001.jpg
case_images: PMC9935967_01_jksr-84-304-g001.jpg
case_images: F1
case_images: A left paravertebral lobulated mass measuring approximately 8 cm was noted at the T6 level with homogenous enhancement, compromising the left neural foramen and central spinal canal with spinal cord compression (Fig. 1A). On spinal MRI, bilateral paravertebral masses revealed diffuse T1 low and T2 heterogeneous high signal intensity (SI) with direct invasion of the epidural space at the T6 level (Fig. 1B). On subsequent fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT, the bilateral paravertebral masses revealed intense FDG uptake (maximum standardized uptake value = 14.3, Fig. 1C). A CT-guided coaxial needle biopsy of the left paravertebral mass was successfully performed (Fig. 1D). And those findings were suggestive of malignant SFT (Fig. 1E), Immunohistochemistry revealed positive staining for CD99, and negative staining for CD34 (Fig. 1F).