Yunus Amran, Muhammad

Hasanuddin University Repository

IJCRI – International Journal of Case Reports and Images, Vol. 3 No. 9, September 201 2. ISSN – [0976-31 98]
IJCRI 201 2;3(9):48–50.www.ijcasereportsandimages.com
MRI appearances of a destructive giant cell tumor andaneurysmal bone cysts of the lumbosacral spine
Muhammad Yunus Amran, Jumraini Tammasse
CASE REPORT
We report a case of a 35­year­old man who washospitalized on January 23, 2008 who complained ofexperiencing weakness on both legs for six months priorto his hospital admission. The weakness started on hisleft leg after he played badminton and lasted for threemonths. Two weeks later, he felt weakness in his rightleg. He also felt cramps and pain on his lower back, andit spread down to the lower leg. The pain was aggravatedby coughing and sneezing. He could not normallyurinate and defecate. There was no history of trauma,fever, chronic cough, diabetes and cardiac disease.Based on neurologic physical examination, movementon the lower limb had decreased. Additionally,pathological reflex at the lower limb, the muscle toneand the physiological reflex decreased as well. Sensoryfunctions were anesthetized from acral until S1dermatome and hypoesthesia from the S1 dermatomeuntil L3 dermatome in both sides. Routine and blood
chemistry analyses revealed the following results: whiteblood cell 8.43/mm3, red blood cell 4.21x106/mm3,hemoglobin 12.7 g/dL, hematocrit 38%; platelet310x103/mm3, blood sedimentation rate 1 hr – 11 mmand 2 hr – 30 mm (normal value for males below 10mm/1st hr glucose (random) 95 mg/dL, total cholesterol194 mg/dL, HDL 46 mg/dL, LDL 70 mg/dL, triglyceride146 mg/dL, uric acid 4.6mg/dL, urea 29mg/dL, creatinine0.73 mg/dL, SGOT 15 mg/dL, SGPT 11 mg/dL, alpha­fetoprotein 1.59 mg/mL (Normal value <12.5 mg/mL),anti TB IgG ­ negative and prostate­specific antigen(PSA) 2.73 mg/mL (normal value <4 mg/mL). Theperspiration test showed no color change from acral upto the knee (spinal cord dermatome L3). An anteriorposterior (AP)/lateral view of lumbosacral X­ray showedthat alignment of lumbosacral vertebrae was changed;destruction of posterior part of lumbar 4–5 vertebraecorpus and destruction of right lumbar 4 pedicles andbilateral lumbar 5 pedicles; narrowing in the vertebraldiscus of L4–5; bone mineralization in normal rangeand soft tissue was normal limit suggesting metastatictumor to the vertebra corpus.An magnetic resonance imaging (MRI) examinationwas performed with and without administration ofintravenous Gadolinium (Gd­DOTA). The resultrevealed an extradural mass with mix­intensity (iso,hypo and hyperintense) in sagittal T1­weighted imagesof the lumbosacral region (Figure 1) and extraduralmass with mix­intensity (iso and hyperintense) insagittal T2­weighted images of the lumbosacral region(Figure 2). Sequential sagittal T2­weighted images Fat­Sat with MR­myelography revealed a clear border,lobulated side with the solid component of the mass,cyst containing blood (level fluid appearance) in thelarge areas that were spreading to the anterior andposterior regions and also damaging the surroundingbones, and compressing thecal sac and nerve rootsbilaterally, that cause stenosis canalis spinalis at thatlevel (Figure 3). These findings suggested destructivegiant­cell tumor and aneurysmal bone cysts in thelumbosacral spine of vertebrae corpus L3–S2 level. Thepatient was recommended neurosurgical operation. Thetumor was biopsied and revealed the histopathology ascarcinoma metastases at the vertebrae (it was very
CLINICAL IMAGES OPEN ACCESS
Muhammad Yunus Amran1 ,2, Jumraini Tammasse3
Affi l iations: 1Department of Bacteriology, Laboratory of
Division Basic Medical Science and Molecular, Graduate
School of Medical Sciences and School of Medicine,
Kyushu University, Fukuoka, Japan; 2Clinical Assistant
Professor and Lecturer, Hasanuddin University Hospital,
Department of Neurology, Faculty of Medicine,
Hasanuddin University, Makassar, South Sulawesi,
Indonesia; 3Clinical Associate Professor and Lecturer,
Hasanuddin University Hospital, Department of
Neurology, Faculty of Medicine, Hasanuddin University,
Makassar, South Sulawesi, Indonesia.
Corresponding Author: Muhammad Yunus Amran, MD, 3-
1 -1 Maidashi, Higashi-ku, Fukuoka, Kyushu University,
Medical Basic Research Building B 2F, 81 2-8582, Japan;
Ph: +81 -92-642-61 30; Fax: +81 -92-642-61 33; Email :
yunus09@bact.med.kyushu-u.ac. jp,
yunus_amran98@yahoo.com
Received: 1 3 February 201 2
Accepted: 06 May 201 2
Published: 01 September 201 2
Amran et al. 48
IJCRI – International Journal of Case Reports and Images, Vol. 3 No. 9, September 201 2. ISSN – [0976-31 98]
IJCRI 201 2;3(9):48–50.www.ijcasereportsandimages.com Amran et al. 49
difficult to determine the primer). Patient himselfwanted to be discharged from the hospital after eleventhday of operation.
DISCUSSION
Spinal tumors which can affect the spinal columnconsist of primary and metastatic tumors. The primaryvertebral tumors of the spine are about 11% of allprimary tumors of musculoskeletal, and only 4.2% of allspinal tumors, including aneurysmal bone cysts (ABC)and giant cell tumors (GCT) [1, 2]. Aneurysmal bonecyst (ABC) was first reported by Jaffe and Lichtensteinin 1942 [3]. They described it as ‘blood­filled sponges’ ofcavernous cysts with walls of woven bone. This tumormay be found in association with other tumors such asgiant cell tumors or as a secondary feature in a variety ofosseous lesions, including giant cell tumors [4, 5]. Inour case report, we showed that the patient complainingweakness of both of his legs was diagnosed with a giantcell tumor and aneurysmal bone cysts of thelumbosacral spine along with primary tumor. Thediagnosis was based not only from the MRI but alsofrom all the examinations, including blood examinationto identify primary tumor of giant cell tumors andaneurysmal bone cysts of the lumbosacral spine.
CONCLUSION
Giant cell tumors and aneurysmal bone cysts of thelumbosacral spine are rare tumors. Radiography can be
Figure 1: Sagittal T1­weighted image of the lumbosacral regionwithout (A) and with (B) intravenous Gd­DOTA contrastshowing degenerative disc disease, lumbar and extraduralmass which was mix­intensity (iso, hipo and hyperintense)without Gd­DOTA contrast and became hyperintense afterinjecting Gd­DOTA contrast intravenously.
Figure 2: Sagittal T2­weighted image of the lumbosacralregion showing, degenerative disc disease, lumbar andextradural mass with mix­intensity (iso and hyperintense)signal.
Figure 3: Sequential sagittal T2­weighted image Fat­Sat withMR­Myelography. (A) Right parasagittal T2WI, (B) Rightparasagittal T2WI, (C) Sagittal T2WI, all of them showing amass at the level of vertebrae corpus L3­S2 with clear border,lobulated side with the solid component, cyst containing blood(level fluid appearance) in the large area that spread toanterior and posterior aspects and also destroying thesurrounding bones and compressing the thecal sac and nerveroots bilateraly that cause stenosis canalis spinalis at that level.
IJCRI – International Journal of Case Reports and Images, Vol. 3 No. 9, September 201 2. ISSN – [0976-31 98]
IJCRI 201 2;3(9):48–50.www.ijcasereportsandimages.com Amran et al. 50
used to diagnose spinal tumors, but CT scan and MRI ismore useful and needed to determine the extent of thetumor. Specifically, in the case of imaging diagnosis,MRI is the gold standard for diagnosing this tumor.
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Amran MY, Tammasse J. MRI appearances of adestructive giant cell tumor and aneurysmal bone cystsof the lumbosacral spine. International Journal of CaseReports and Images 2012;3(9):48–50.
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doi:10.5348/ijcri­2012­09­184­CI­14
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Author ContributionsMuhammad Yunus Amran – Substantial contributionsto conception and design, Acquisition of data, Analysisand interpretation of data, Drafting the article, Revisingit critically for important intellectual content, Finalapproval of the version to be publishedJumraini Tammasse – Substantial contributions toconception and design, Acquisition of data, Analysis andinterpretation of data, Drafting the article, Revising itcritically for important intellectual content, Finalapproval of the version to be published
GuarantorThe corresponding author is the guarantor ofsubmission.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© Muhammad Yunus Amran et al. 2012; This article isdistributed under the terms of Creative CommonsAttribution 3.0 License which permits unrestricted use,distribution and reproduction in any means providedthe original authors and original publisher are properlycredited. (Please see www.ijcasereportsandimages.com/copyright­policy.php for more information.)
REFERENCES
1. Boriani S, Biagini R, De Iure F, et al. Primary bonetumors of the spine: A survey of the evaluation attreatment at the Instituto Ortopedico Rizzoli.Orthopedics. 1995; 18:993–1000.2. Chi JH, Bydon A, Hsieh P, Witham T, Wolinsky JP,Gokaslan ZL. Epidemiology and demographics forprimary vertebral tumors. Neurosurg Clin NorthAm. 2008; 19:1–4.3. Jaffe JL, Lichtenstein L. Solitary unicameral bonecyst with emphasis on the roentgen picture, thepathologic appearance and the pathogenesis. ArchSurg. 1942; 44:1004–1025.
4. Saccomanni B. Aneurysmal bone cyst of spine: areview of literature. Archives of Orthopaedic andTrauma Surgery. 2008; 128:1145–7.5. Ropper AE, Cahill KS, Hanna JW, McCarthy EF,Gokaslan ZL, Chi JH. Primary vertebral tumors: areview of epidemiologic, histological, and imagingfindings, Part I: benign tumors. Neurosurgery. 2011;69:1171–80.


MRI appearances of a destructive giant cell tumor and aneurysmal bone cysts of the lumbosacral spine

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MRI appearances of a destructive giant cell tumor and aneurysmal bone cysts of the lumbosacral spine

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