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Solid variant of aneurysmal bone cyst of the thoracic spine: a case report.

Al-Shamy G, Relyea K, Adesina A, Whitehead WE, Curry DJ, Luerssen TG, Jea A - J Med Case Rep (2011)

Bottom Line: An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits.The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation.Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. ahjea@texaschildrenshospital.org.

ABSTRACT

Introduction: The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery.

Case report: An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain.

Conclusions: Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine.

No MeSH data available.


Related in: MedlinePlus

Pre-operative axial (A) T1-weighted and (B) T2-weighted MRI demonstrate a large heterogeneous low and high signal intensity mass lesion involving T6. (C) Enhanced T1-weighted MRI shows a more homogenous high signal T6 mass.
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Figure 2: Pre-operative axial (A) T1-weighted and (B) T2-weighted MRI demonstrate a large heterogeneous low and high signal intensity mass lesion involving T6. (C) Enhanced T1-weighted MRI shows a more homogenous high signal T6 mass.

Mentions: A computed tomography (CT) scan of the thoracic spine (Figure 1) demonstrated an expansile osteolytic lesion occupying the left part of the vertebral body of T6 destroying the lamina and pedicle as well as the associated rib at that level. MRI of the thoracic spine (Figure 2) revealed a large hypointense lesion on T1-weighted images with homogenous enhancement. The lesion showed mixed low-signal intensity with scattered high-signal intensity areas on T2-weighted MRI, suggesting microcysts.


Solid variant of aneurysmal bone cyst of the thoracic spine: a case report.

Al-Shamy G, Relyea K, Adesina A, Whitehead WE, Curry DJ, Luerssen TG, Jea A - J Med Case Rep (2011)

Pre-operative axial (A) T1-weighted and (B) T2-weighted MRI demonstrate a large heterogeneous low and high signal intensity mass lesion involving T6. (C) Enhanced T1-weighted MRI shows a more homogenous high signal T6 mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141711&req=5

Figure 2: Pre-operative axial (A) T1-weighted and (B) T2-weighted MRI demonstrate a large heterogeneous low and high signal intensity mass lesion involving T6. (C) Enhanced T1-weighted MRI shows a more homogenous high signal T6 mass.
Mentions: A computed tomography (CT) scan of the thoracic spine (Figure 1) demonstrated an expansile osteolytic lesion occupying the left part of the vertebral body of T6 destroying the lamina and pedicle as well as the associated rib at that level. MRI of the thoracic spine (Figure 2) revealed a large hypointense lesion on T1-weighted images with homogenous enhancement. The lesion showed mixed low-signal intensity with scattered high-signal intensity areas on T2-weighted MRI, suggesting microcysts.

Bottom Line: An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits.The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation.Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. ahjea@texaschildrenshospital.org.

ABSTRACT

Introduction: The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery.

Case report: An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain.

Conclusions: Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine.

No MeSH data available.


Related in: MedlinePlus