Schmorl node - acute

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-contrast enhancement, as seen in this case, can be seen in acute herniations but given the history, there was a concern for metastatic disease which precipitated the Schmorl node formation, thus the reason for bone biopsy. 

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

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

TranspedicularA transpedicular 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.