case_images: PMC11729148_01
case_images: The timeline of the diagnosis and treatment course of the patient in the present case. CT = computed tomography.
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case_images: PMC11729148_01_medi-104-e41256-g001.jpg
case_images: F1
case_images: A 23-year-old female presented to the Department of Spinal Orthopedic Surgery on June 30, 2023, with a month-long history of lower back pain, which worsened significantly over the preceding ten days, accompanied by progressive numbness and weakness in her lower limbs (Fig. 1).
case_images: Imaging data before the first surgery. (A) Orthopantomogram of lumbar spine. (B) Sagittal CT image of the lumbar spine. (C) CT transverse section of lumbar spine. (D) Lung CT cross-section. (E, F) lumbar spine MRI cross-sections. (G, H) Lumbar spine MRI sagittal view. CT= computed tomography, MRI = magnetic resonance imaging.
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case_images: PMC11729148_01_medi-104-e41256-g002.jpg
case_images: F2
case_images: Initial imaging at our hospital identified a left lumbar psoas major swelling from L4 to sacral vertebra 1 (S1) and an irregular soft tissue mass posterior to the L4-S1 vertebrae with internal signal heterogeneity (Fig. 2A-H). Computed tomography (CT) scans of the chest revealed diffuse pulmonary nodules of varying sizes, raising suspicion for metastatic disease or disseminated tuberculosis (Fig. 2D).
case_images: Imaging data after the first surgery. (A, B) Review of lumbar spine front and side view pictures. (C, D) Hematoxylin and eosin stained pictures of the first pathological examination. (E-G) Postoperative review chest computed tomography pictures.
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case_images: PMC11729148_01_medi-104-e41256-g003.jpg
case_images: F3
case_images: Given her neurological symptoms and imaging findings, the patient underwent posterior lumbar internal fixation, nerve decompression, and biopsy on July 3, 2023 (Fig. 3A-D). Postsurgical CT scans showed diffuse pulmonary nodules, which had grown compared to previous scans (Fig. 3E-G).
case_images: Intraoperative and postoperative images of the second surgery. (A) intraoperative photographs of the second surgery. (B, C) Postoperative chest computed tomography pictures. (D, E) Hematoxylin and eosin stained pictures of the second pathological examination.
case_images: medi-104-e41256-g004.jpg
case_images: PMC11729148_01_medi-104-e41256-g004.jpg
case_images: F4
case_images: Due to inconclusive pathology and persistent symptoms, a second surgery was performed on July 20, 2023, through a left anterior abdominal approach to excise the lumbar psoas major tumor (Fig. 4A). Key markers included Bcl-2 (+), ALK (+), CD99 (+), and Ki-67 (~80%+) (Fig. 4D and E). Postoperative imaging on July 25, 2023, revealed further progression of pulmonary nodules (Fig. 4B and C).