Presentation
Leg weakness.
Patient Data
Pathological compression fracture of T5, with almost complete loss of anterior height causes acute thoracic kyphosis at this level. The combination of kyphosis and extraosseous tumor from the posterior T5 vertebral body causes severe spinal canal stenosis, without abnormal cord signal. Extraosseous extension of tumor is also noted anterior to the T4-6 vertebral bodies. Moderate right T4/5 and right T5/6 intervertebral foraminal stenosis. Mild compression fractures of T4 and T6. The rest of the thoracic vertebral bodies demonstrate normal alignment. Combination of facetal and ligamentum flavum hypertrophy at T9/10 and T10/11 cause moderate spinal canal stenosis.
Mixed sclerotic and lytic metastases throughout the spine, which extend into the posterior elements.
Several metastatic vertebral body fractures, the most pronounced at T5 with a resultant kyphosis.
Case Discussion
This case illustrates extensive vertebral body metastatic disease. The patient has a known history of breast cancer, with known metastatic disease. Bony metastases was confirmed on a prior biopsy of bone.
Histology
MICROSCOPIC DESCRIPTION: The sections show features of metastatic poorly differentiated adenocarcinoma in the medullary spaces. The tumor forms nests. No glandular structures are noted. The tumor cells have enlarged pleomorphic nuclei, prominent nucleoli and small amounts of cytoplasm. No evidence of lymphovascular invasion is seen.
- GATA-3 positive, in keeping with breast primary.
- TTF-1 is negative.
- Estrogen receptor: Positive. About 95% of the tumor cells show strong nuclear staining (3+).
- Progesterone receptor: Positive. About 5% of the tumor cells show strong nuclear staining (3+).
- HER-2: Negative (1+). About 40% of the tumor cells show weak membranous staining.
DIAGNOSIS: Left femoral reamings: Metastatic poorly differentiated adenocarcinoma, in keeping with breast primary.