case_images: PMC9168289_01
case_images: An 18-year-old man suffering from left-sided neck stiffness and shoulder pain underwent spinal magnetic resonance imaging. Magnetic resonance images of the tumor. (A and B) Sagittal T2-weighted and short tau inversion recovery images indicated that the lesion on the left posterior vertebral arch of T2 (white arrows) was hyperintense compared with the bone marrow extending to the T2 vertebral body (yellow arrows). (C) The lesion was hypointense on axial T1-weighted images. (D) The mass compressed the spinal cord (arrow). (E) The mass was markedly enhanced on axial T1-weighted with contrast agent and extended to the paraspinal tissue (arrow).
case_images: JCIS-12-21-g001.jpg
case_images: PMC9168289_01_JCIS-12-21-g001.jpg
case_images: F1
case_images: T2 [Figure 1]. The mass had ill-defined borders, appeared hypointense on T1-weighted (T1W) images, and hyperintense on T2-weighted (T2W) and short tau inversion recovery (STIR) images. The tumor extended into paraspinal tissue and the spinal canal, causing spinal cord compression [Figure 1]. This tumor was markedly enhanced on T1W with a contrast agent.
case_images: An 18-year-old man suffering from left-sided neck stiffness and shoulder pain underwent computed tomography. Computed tomography scan revealing that the tumor was lytic with a rim of sclerosis and a small area of internal calcification (arrow).
case_images: JCIS-12-21-g002.jpg
case_images: PMC9168289_01_JCIS-12-21-g002.jpg
case_images: F2
case_images: A computed tomography (CT) image showed that the tumor was mostly lytic, with a rim of sclerosis and small areas of internal calcification [Figure 2].
case_images: An 18-year-old man suffering from left-sided neck stiffness and shoulder pain underwent digital subtraction angiography. (A) Selective angiogram demonstrated a hypervascular tumor with a feeding artery arising from the left thyrocervical trunk (arrow). (B) Postembolization angiogram showed complete devascularization, with no reflux into the radiculomedullary artery (arrow).
case_images: JCIS-12-21-g003.jpg
case_images: PMC9168289_01_JCIS-12-21-g003.jpg
case_images: F3
case_images: The selective embolization of the feeding arteries was performed using 250-micron embozene microspheres, resulting in the successful occlusion of all branches supplying the tumor while conserving the other branches of the left thyrocervical trunk [Figure 3].
case_images: PMC9168289_02
case_images: A 68-year-old man with moderate back pain that radiated to the legs underwent spinal magnetic resonance imaging. The L4 vertebral body was isointense on sagittal T2-weighted (A) (arrow) and sagittal T1-weighted (C) (arrow) images but hyperintense on short tau inversion recovery (B) (arrow) images compared with the bone marrow.
case_images: JCIS-12-21-g004.jpg
case_images: PMC9168289_02_JCIS-12-21-g004.jpg
case_images: F4
case_images: T2W but hyperintense on STIR [Figure 4]. The initial diagnosis was bone marrow edema. Therefore, we decided to perform a spinal CT.
case_images: A 68-year-old man with moderate back pain that radiated to the legs underwent computed tomography. (A and B) The lesion was well-defined and osteolytic, without sclerotic borders or internal calcification (arrow). (C) A CT-guided biopsy of the lesion was performed.
case_images: JCIS-12-21-g005.jpg
case_images: PMC9168289_02_JCIS-12-21-g005.jpg
case_images: F5
case_images: On CT, a well-defined osteolytic lesion could be observed without a sclerotic border and no evidence of internal mineralization [Figure 5].
case_images: A 68-year-old man with moderate back pain that radiated to the legs underwent digital subtraction angiography. A markedly hypervascular tumor at the L4 vertebral was observed, receiving blood from the bilateral L4 segmental arteries (A and B) (arrow). (C) Post-embolization angiogram demonstrated no residual tumor (arrow).
case_images: JCIS-12-21-g006.jpg
case_images: PMC9168289_02_JCIS-12-21-g006.jpg
case_images: F6
case_images: Selective angiography demonstrated a feeding vessel originating from the bilateral L4 segmental arteries [Figure 6]. Based on the tumor location, the tumor feeders were expected to arise from the branches of the L4 segmental arteries, and the embolization of the proximal and trunk L4 segmental arteries using glue (N-butyl cyanoacrylate mixed with lipiodol at a 1:2.5 ratio) was successful [Figure 6].