title: Intraosseous malignant peripheral nerve sheath tumor with focal epithelioid differentiation of the thoracic spine.
abstract: The authors describe an extremely rare case with malignant peripheral nerve sheath tumor (MPNST) with focal epithelioid differentiation presenting as an intraosseous lesion of the spine. A 75-year-old woman presented with progressive paraplegia caused by epidural mass arising from the posterior element of the T7 vertebra. At surgery, the lesion was noted to originate from the T7 vertebra and separate from the dura and spinal nerve roots. The patient died of tumor metastases to the lungs six months after the initial presentation. Histological diagnosis was MPNST. However, the tumor also contained cystic structures lined by epithelioid cells, requiring differentiation from synovial sarcoma. From the histological and immunohistochemical features, as well as the absence of SYT-SSX fusion gene expression, the diagnosis of MPNST with focal epithelioid differentiation was made. This is the first case report of intraosseous MPNST of the spine with a peculiar biphasic appearance.
authors.affiliation: Department of Orthopedic Surgery, Akita University School of Medicine, Akita 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishikawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
authors.forename: Kyoji
authors.initials: K
authors.lastname: Okada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Enomoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
mesh_terms: D000368:Aged; D015622:Epithelioid Cells / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018317:Nerve Sheath Neoplasms / Q000473:pathology*; D015514:Oncogene Proteins, Fusion / Q000378:metabolism; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology*; D013131:Spine / Q000473:pathology*; D013904:Thoracic Vertebrae
chemical_list: D015514:Oncogene Proteins, Fusion; C116512:SYT-SSX fusion protein