Malignant fibrous histiocytoma of the thoracic spine manifesting as rapidly progressive compressive myelopathy.
A 75-year-old woman presented with an extremely rare case of malignant fibrous histiocytoma (MFH) arising in the thoracic spine, causing compression fracture and manifesting as rapidly progressive compressive myelopathy resulting in progressive gait disturbance and weakness of the bilateral legs. Computed tomography and magnetic resonance imaging demonstrated a solid enhanced intravertebral mass destroying the vertebral bodies at the T7 and T8 levels. Maximum resection of the lesion was performed through wide laminectomy from T7 through T9, followed by vertebroplasty using calcium phosphate paste and posterior fixation with a spinal fixation system. Histological examination showed proliferation of pleomorphic spindle-shaped cells having large irregular nuclei with hyperchromasia with storiform pattern and collagenous stroma, consistent with a diagnosis of MFH. This case illustrates the possibility of rapid maximum decompression surgery from the posterolateral side if MFH manifests as progressive transverse myelopathy.
Department of Neurosurgery, Miyazaki Prefectural Hospital, Japan. hochiai@fc.miyazaki-u.ac.jp
Hidenobu
H
Ochiai
Hirokazu
H
Kawano
Yoshiya
Y
Shimao
Tohru
T
Hayashi
Hiroki
H
Yamada
D000208:Acute Disease; D000368:Aged; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D020335:Paraparesis / Q000209:etiology; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology*; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty