case_images: PMC4431055_01
case_images: Computed tomography axial bone window (a) and soft-tissue mediastinal window (b) sections show an expansile, osteolytic lesion arising from the left lateral arch elements of C4 vertebra having an enhancing soft tissue component. The cranio-caudal extent and displacement of vascular and soft tissue structures is appreciated on sagittal CT reconstruction (c) image. Axial T1-weighted precontrast (d), T2-weighted (e) and T1-weighted postcontrast (f) images better demonstrate the extent of the soft tissue component
case_images: SNI-6-182-g001.jpg
case_images: PMC4431055_01_SNI-6-182-g001.jpg
case_images: F1
case_images: Computed tomography (CT) of neck showed a large expansile lytic lesion with epicentre in the left pedicle and body of C4 vertebrae, extending into the lamina and spinous process [Figure 1a-c]. The lesion had large prevertebral and paravertebral soft tissue components causing anterior displacement of the carotid vessels and partial encasement of the V2 segment of the left vertebral artery [Figure 1c]. T1W images and heterogenously iso- to hyper-intense on T2W images; with intense, relatively homogenous, postcontrast enhancement [Figure 1d-f]. There was an intraspinal epidural component displacing the spinal cord postero-laterally to the right.
case_images: (a) Photomicrograph showing scattered multinucleated osteoclastic giant cells and focal osteoid production (arrow) in a background of fibroblastic proliferation (H and E x10). (b) A few dilated blood filled spaces are seen lined by multinucleated osteoclastic giant cells (H and E x10). The absence of atypia is key to diagnosis of s-ABC
case_images: SNI-6-182-g002.jpg
case_images: PMC4431055_01_SNI-6-182-g002.jpg
case_images: F2
case_images: Histology revealed marked fibroblastic proliferation and scattered giant cells, with presence of focal osteoid production, which was not associated with malignant cells [Figure 2a]. A few blood-filled spaces, rimmed by giant cells and hemosiderin laden macrophages, were also seen [Figure 2b].
case_images: Follow-up MR imaging (at 10 months postsurgery): Sagittal T1-weighted (a), T2-weighted (b) and T1-weighted postcontrast (c) images depict spinal fixation with decompressed spinal cord. The T1-weighted (d), T2-weighted (e) and T1-weighted postcontrast (f) axial sections confirm the residual lesion along the left lateral arch of the vertebra with associated small soft tissue component
case_images: SNI-6-182-g003.jpg
case_images: PMC4431055_01_SNI-6-182-g003.jpg
case_images: F3
case_images: FDG (Fluorodeoxyglucose) avid lesion over the posterior elements of C4 and C5 vertebrae. Follow-up MRI at 10 months showed residual lesion centered at the left side lamina and spinous process of C4 and C5 vertebrae with no significant associated soft tissue component or recurrence [Figure 3a-f].