case_images: PMC11329902_01
case_images: (A) Sagittal pre-contrast T1-weighted fat-saturated magnetic resonance imaging of lumbar spine demonstrates marrow replacing lesion within the L4 vertebral body with extension into the epidural space and associated cortical destruction of the anterior and posterior cortex with bulging of the anterior and posterior longitudinal ligament and (B) epidural extension of tumor extends along the dorsal aspect of the vertebral bodies from the L3 to the L5 level. There is circumferential epidural tumor which extends from the L3-L4 level to the L5 level. There is involvement of the spinous processes as well as the bilateral pedicles.
case_images: 10.1177_2632010X241272377-fig1.jpg
case_images: PMC11329902_01_10.1177_2632010X241272377-fig1.jpg
case_images: fig1-2632010X241272377
case_images: Magnetic resonance imaging (MRI) of the spine (Figure 1) and lower extremities were performed and showed expansile lesion of the L4 vertebral body with critical epidural compression of the cauda equina and severe spinal canal stenosis at the L4 level.
case_images: (A) The specimen shows multiple fragments of bone and soft tissue involved by a diffuse atypical lymphoid infiltrate with patchy crush artifact, composed of small to medium sized cells with high N:C ratio, scant cytoplasm, hyperchromatic nuclei, and inconspicuous nucleoli. Apoptosis is present. No necrosis is appreciated. Immunophenotypically, the atypical/neoplastic cells are positive for PAX-5 (B), CD19 (C), and TdT (D). Magnification 400x.
case_images: 10.1177_2632010X241272377-fig2.jpg
case_images: PMC11329902_01_10.1177_2632010X241272377-fig2.jpg
case_images: fig2-2632010X241272377
case_images: The final pathology of the epidural mass at L4 spine showed (Figure 2A-D) a diffuse atypical lymphoid infiltrate composed of small to medium sized cells with high N:C ratio, scant cytoplasm, hyperchromatic nuclei, and inconspicuous nucleoli.