Department of Pathology, University of Oklahoma Health Sciences Center
A 37 year-old man with a bone eroding mass in cervical spine.
Clinical information: The patient was a 37 year-old man who complained of pain in the back of the left neck which radiated to the left shoulder. On physical examination, there was mild weakness in his left arm. A CT scan was performed and revealed a bone eroding mass in the C7 spine as illustrated below. The mass was excised and representative images are showed below:
Click thumbnails to see pictures.
CT scan demonstrated an expansile lesion in foramen without invasion of the bone. These imaging properties are more consistent with an extra-osseous expansile mass than an intrinsic bone tumor that probably arise in the foramen (Panel ).
Histologically, the edge of the tumor is lined by some papillary structures (arrow in Panel A and B). The tumor per se, however, is composed of solid sheets of cells. In some areas, there are areas of foamy cells consistent with histiocytes (arrow in Panel C and D). On high magnification, the tumor is composed of densely packed spindle cells with small but hyperchromatic nuclei (Panel E). Some pigmented cells (Panel F) and lymphocytes (difficult to tell from these pictures) are present. On special stains, some hemosiderin is present and well demonstrated by Prussian blue stain (iron stain) (Panel G). The pigmented in cells are positive Fontana-Masson stain (Panel H). The foamy cells are confirmed to be histiocytes with immunohistochemistry for CD68 (Panel I). Clusters of lymphocytes are also demonstrated by immunohistochemistry for leukocyte common antigen (LCA) (Panel J).
| DIAGNOSIS: Pigmented villonodular tenosynovitis. |
Comment:
The CT scan is quite helpful in this case. The common entities that would give rise to this extrinsic mass in this location include schwannoma and, far less commonly, schwannoma. Unless the patient has neurofibromatosis 1 (NF1), neurofibroma is a tumor that prefer the distal part of the peripheral nervous system and does not arise in this location in a typical setting. Pigmented villonodular tenosynovitis has been described in this location but it is a rare lesion in the cervical spine.
Discussion: In Preparation
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