case_images: PMC10874295_01
case_images: Computed tomography image and magnetic resonance images on arrival. Computed tomography image (CT) shows a Th5 level vertebral fracture (A). Magnetic resonance images show the Th5 vertebral fracture and spinal compression at the same level (B: T2-weighted image, C: T1-weighted image, D: STIR. MRI T2-weighted axial images show spinal compression from the ventral side continuous vertebral body (E, F).
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case_images: PMC10874295_01_cureus-0016-00000052524-i01.jpg
case_images: FIG1
case_images: Spinal magnetic resonance imaging (MRI) revealed spinal cord compression due to pathological fracture at Th5 (Figure 1).
case_images: X-ray photographs and magnetic resonance images after the first surgery. Frontal view (A) and lateral view (B) of X-ray images show good posterolateral fixation by screws and rods. After surgery, spinal compression by tumor is improved at the Th5 level (C, D).
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case_images: PMC10874295_01_cureus-0016-00000052524-i02.jpg
case_images: FIG2
case_images: Th2 to Th8, and partial removal with tumor tissue sampling for analysis (Figure 2). These procedures were performed using CT-based navigation.
case_images: First and second surgical pathological specimens. The first surgical specimen stained with hematoxylin-eosin showed necrosis and small lymphocytes (A: x100, B: x400). Tuberculosis examinations did not show positive staining for Ziehl-Neelsen (C) and Grocott's (D). The second surgical specimen stained with hematoxylin-eosin had similar findings (E: x100, F: x400).
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case_images: PMC10874295_01_cureus-0016-00000052524-i03.jpg
case_images: FIG3
case_images: Pathology results showed granuloma with caseous necrosis (Figure 3), and various tests (PCR, bacterial culture test, TSOPT, Gaffky) were negative for tuberculosis. However, the second surgical specimen also showed that the lymphocytes were relatively small and did not show atypia, so a definitive diagnosis remained elusive (Figure 3).
case_images: Magnetic resonance images before and after the second surgery. MRI T2-weighted images show the recompression of the spinal cord by the tumor (A), leading to a second operation (B).
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case_images: PMC10874295_01_cureus-0016-00000052524-i04.jpg
case_images: FIG4
case_images: A second tumor resection was thus performed (Figure 4), which temporarily ameliorated her symptoms.
case_images: Magnetic resonance images after the third surgery. After third tumor removal, spinal cord compression was improved, as seen in the MRI T2-weighted image at the Th5 level.
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case_images: FIG5
case_images: Histopathology of the third specimen conclusively identified diffuse large B-cell lymphoma (Figures 5, 6).
case_images: Second surgical pathological specimen. The surgical specimen stained with hematoxylin-eosin shows atypical large lymphocytes compared to the previous specimen. (A: x100, B: x400). Immunohistochemical examinations revealed that the atypical cells were positive stained for CD20 (C) and negative stained for CD5 (D).
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case_images: PMC10874295_01_cureus-0016-00000052524-i06.jpg
case_images: FIG6
case_images: Histopathology of the third specimen conclusively identified diffuse large B-cell lymphoma (Figures 5, 6).