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spine - entire

A man from Milan with difficulty walking

Case Identification
Case ID Number: 
20090727MM
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 28 year old man from northern Italy complained of mild difficulty walking for one year. He did not complain of pain. The patient had no history of unusual travel or exposure.

Radiological findings:: 
The vital signs were normal. No fevers had been recorded. On examination, the patient appeared comfortable and moved easily without obvious pain. There was no gross defect in the patient's ability to ambulate. There was no clonus. However, an examining neurologist had noted normal sensorium, left sided lower extremity hyperreflexia, and bilateral abnormal Babinski reflexes. A radiograph of the chest revealed multiple pulmonary nodules, and a lesion in the second thoracic vertebrae. Further radiographic examination of the spine showed that the lesion in T2 had caused extensive anterior and posterior changes and a soft tissue abnormality adjacent to the right side of the vertebral body. A plain radiograph, CT scan of T2, and a saggital MR image of the spinal column are shown. A CT images of the lungs are shown. A bone scan showed abnormal uptake in the region of T1 - T3 in the spine but no other abnormality (not shown).
Laboratory results:: 
The WBC was 10.70 (4.5 - 9.5) RBC was 5.12 (4.5 - 5.9) the hematocrit was 15.3 (14 - 18) platelets were 249 (130 - 400). There were 82.9% neutrophils, 10.9% lymphocytes, and 5.94% monocytes. Electrolytes, liver enzymes, alkaline phospate, and PT/PTT were normal. ESR was 6 (normal, less than 15) and C-reactive protein was negative (less than 0.5). There were no Bence-Jones proteins in the serum or urine. Urinalysis was normal. TSH was 0.78 (0.30 - 4.00) and TT4 was 12.4 (8.0 - 20.0). The patient was negative for HIV. A Mantoux skin test was non-reactive (normal). VDRL and TPHA were negative (no evidence for siphylis).
Pathology results:: 
An open biopsy of the spinal lesion was performed. Grossly, there was no purulence or granulomatous changes nor any soft tissue mass or obvious tumor. There was discoloration of the bone making it appear dark grey or black, similar to the black discoloration from metal debris from a failed orthopedic implant. Microscopically, the lesion contained irregular anastomosing vascular channels. The channels are lined by plump endothelial cells without pleomorphism or mitotic activity. Both the background stroma and the cells lining the vascular channels stain positive for reticulum.
Special Features of this Case:: 
What is the diagnosis? What treatment would you propose? What do the lung nodules represent?

An active 31 year old woman had focal back pain.

Case Identification
Case ID Number: 
20091117AE
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

An active thirty-one year old woman had focal back pain and a lesion in the second lumbar vertebra. Initial work-up including a CT revealed a solitary,lesion with a latent appearance. Primary treatment was non-operative, but after six months the pain was still present, and the patient complained of significant limitations of her lifestyle and was unable to perform many outdoor activities.

Radiological findings:: 
A repeat CT scan did not show any progression of the lesion, and a CT guided needle biopsy revealed the histological appearance shown

Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is a solitary, expansile and erosive lesion of bone. The cause of this non-neoplastic lesion is unknown.
Most patients are under 20, but the tumor can occur at any age.
The tumor presents with pain for several weeks with local swelling. Any bone may be involved, but the most common sites include the long bones and the posterior parts of the spinal vertebra.On xrays, the lesion has a destructive, lytic, and expansile appearance.
Most ABC's are sucessfully treated with curettage and packing with bone chips or bone cement.

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Chondroblastoma

Chondroblastoma is a rare, benign tumor derived from chondroblasts. It is found in the epiphysis of long bones, usually of the lower extremity. The most common site is the distal femur followed by the proximal femur, proximal humerus and proximal tibia.
The tumor has a preference for males over females and the mean age of presentation is approximately 20 years old.
The tumor presents as a child, teenager or young adult with pain and swelling in a joint, usually the shoulder, knee, or hip. Occasionally the tumor can occur in the spine causing back pain. In the xray, the tumor forms an expansile lesion in the epiphysis with calcifications
Curettage is the treatment of choice for most of these tumors.

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