case_images: PMC11287744_01
case_images: (A) Pre-operative selected axial CT image at the level of T6 "bone window" demonstrating a subtle poorly-defined abnormal density within the vertebral body, with multiple foci of intra-lesional calcification. (B) Pre-operative sagittal MRI spine, T2 fat-saturated image demonstrating high T2 signal abnormality within the vertebral body of T6. No vertebral body compression, collapse or destruction seen. There is another abnormality of focal intraspinal high T2 signal abnormality at the same level "the arrow," which represents the EDH. Unfortunately, the T1-sequence "not shown here" was of low imaging quality due to patient-related motion artifact. The hematoma was confirmed intra-operatively. At this point, the Radiology Neurosurgery team interpreted the vertebral body lesion as a hemangioma, with a small extradural hematoma at the same level. Due to the acute presentation of the patient, the decision was made to take the patient to the OR to evacuate the extradural hematoma. (C) A postoperative sagittal CT image "bone window" showing a short-segment vertebral fixation at the levels of T5-T7.
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case_images: Urgent CT and MRI showed an abnormal epidural density/intensity at the level of D6 (Figure 1A and B), requiring urgent surgical intervention to alleviate spinal cord compression. Short segment fusion at the levels of T5-T7 was performed (Figure 1C).
case_images: (A) A sagittal T2W MRI spine of the same patient 6 months postoperative demonstrating significant progression of the signal abnormality in the vertebral body of T6. This is associated with a large heterogeneously high T2 soft tissue component bulging into the epidural spinal canal with extensive compression of the spinal cord and right neural foramen at the same level. There is also minimal caudal migration to the level of mid D7. (B) axial T2W MRI & (C) an axial CT at the T6 level showing the previously described signal abnormality, extending to the right pedicle and lamina with corresponding bony erosion well-demonstrated in the provided CT image. The MRI shows significant compression of the spinal cord, which is compressed and displaced to the left side, but with no intramedullary signal abnormality. (D) A coronal image of MR myelography showing a significant filling defect at the level of T6 and T7 confirming the intraspinal extension of the lesion and significant cord compression. (E) A postoperative sagittal CT image of the dorsal spine demonstrating interval longer fixation of the vertebrae at the levels of T4, T5 and T7, T8.
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case_images: MRI showed a heterogenous 5 x 4 x 3.5 cm soft tissue mass from the vertebral body and right pedicle of T6, protruding in the epidural space and compressing the spinal cord. Magnetic resonance myelography demonstrated significant compression of the cord (Figure 2). The fixation consisted of segmental rod-screw constructs 2 levels above (T4, T5) and 2 levels below (T7, T8) (Figure 2E).
case_images: Light microscopic picture of chordoma (A) Tumor with multilobulated growth pattern of epithelioid cells. The lobules showed anastomosing nests or cords of acidophilic tumor cells. (B) Higher magnification of the tumor showing cords of acidophilic, vacuolated small and medium-sized cells with rounded nuclei, most of which had low-grade atypia. The tumor cells arranged in a basophilic fibromyxoid stroma, with no evidence of necrosis. H&E (A) 100x, (B) 400x.
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case_images: Histopathological examination confirmed chordoma diagnosis (Figure 3).