Acute Schmorl node

Case contributed by Dr Henry Knipe

Presentation

History of colorectal carcinoma. Follow-up from PET avid lumbar spine lesion.

Patient Data

Age: 65 years
Gender: Male
MRI

T1 hypointense / T2 hyperintense lesion centred on the L3 inferior endplate involving both intervertebral disc and vertebral body. Inferior endplate cortex appears to be superiorly displaced by the lesion (best seen on the sagittal T2FS sequence) with surrounding post contrast enhancement. No other bone lesion. 

The patient was referred for a CT guided bone biopsy. 

CT

Reformats from prebiopsy planning CT

Large lucent lesion centred on the inferior portion of the L3 vertebral body with apparent loss of the inferior endplate. Mild surrounding bony sclerosis. 

CT

Transpendicular bone biopsy was performed. 

Histopathology report

MICROSCOPIC DESCRIPTION: The sections show multiple fragments of bone and crushed marrow content. No evidence of malignancy is seen. No active inflammation is present.

DIAGNOSIS: L3 vertebral body lesion Bx: Unremarkable bone and crushed marrow content. No evidence of malignancy seen. Immunohistochemistry will be performed to help exclude a subtle metastatic carcinoma and an addendum report will follow.

SUPPLEMENTARY REPORT Immunohistochemistry is negative with AE1/AE3 and CAM5.2. No evidence of a carcinoma is seen.

Case Discussion

The findings on the MRI are suggestive of an acute Schmorl node with a T2 hyperintense lesion involving the disc. Surrounding oedema and post contrast enhancement, as seen in this case, can be seen in acute herniations but given the history there was concern for metastatic disease which precipitated the Schmorl node formation, thus the reason for bone biopsy. 

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Case information

rID: 56636
Case created: 14th Nov 2017
Last edited: 15th Nov 2017
Inclusion in quiz mode: Included

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