Vertebral metastases

Case contributed by A.Prof Frank Gaillard

Presentation

Neck pain

Patient Data

Age: 80 years
MRI

C5 and C6 vertebral body edema and enhancement are associated with mild restricted diffusion and a small focus of enhancement in the intervening intervertebral disc on the left. Left anterior epidural soft tissue thickening and enhancement extends into the neural foramen and prevertebral space, associated with displacement of the cord posteriorly, but without associated cord indentation. No discrete fluid collection identified. The cord is normal in signal in caliber, with no enhancement or abnormal signal identified.

Comment:

The differential is between diskitis/osteomyelitis, associated with a left anterior epidural, foraminal and prevertebral phlegmon or a metastatic deposit. 

CT

There is a multi-lobulated mass within the right upper lobe with adjacent further smaller satellite nodules. No other pulmonary nodules or mass lesions are seen given the limitation of 5 mm slices. There are no pleural or pericardial effusions. There are no enlarged mediastinal, hilar or axillary lymph nodes. The coronary arteries are heavily calcified. 

Case Discussion

The patient went on to have a cervical decompression.

Histology

Sections show sheets of tumor cells containing pale eosinophilic cytoplasm, oval hyperchromatic nuclei and prominent nucleoli. Focal tumor necrosis is present. Frequent mitoses are observed.

Immunohistochemical results show tumor cells stain: POSITIVE: CKAE1/3, CK7, TTF1. NEGATIVE: CAM5.2, CK20, p40, CD68, S100, Tyrosinase, CD1a, CD79a, CD138, PSA, Thyroglobulin, Calcitonin. The Ki67 proliferation index is approximately 70%.

FINAL DIAGNOSIS: Cervical epidural mass: poorly differentiated carcinoma, most consistent with lung primary.

Discussion

It is not always trivial to distinguish metastatic disease from infection. In this instance, involvement of two adjacent vertebrae with involvement of the lateral disc does raise the possibility of infection. The CT scan of the chest was obtained after cervical decompression. 

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Case information

rID: 50307
Published: 4th Aug 2018
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Included

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