A 50-year-old male patient was referred to our hospital, with a 4-month history of neck pain and gradually progressive weakness of all four limbs. Over the past 2 weeks, the patient noticed significant deterioration and became bed bound. The patient denies any previous history of trauma, malignancy, or medical history of note. Clinical examination revealed spastic quadriparesis of 3/5 with 80% decreased sensation of all modalities below C5. Sphincters were found to be intact.\nPlain X-ray cervical spine on anterior-posterior (AP) view showed a large lucent lesion replacing the C5 vertebra with loss of the left pedicle []. The magnetic resonance imaging (MRI) of the cervical spine demonstrated a T1 and T2 isointense, expansile mass lesion involving the C5 vertebral body extending into the left pedicle but sparing neural foramina. On T2, small hyperintense intralesional cavity was noted in the anterior part. The lesion extended across the C5/6 intervertebral disc and into the anteroinferior part of the C4 vertebra. Significant cord compression with absent thecal sac against C5 was noted. The lesion enhanced homogeneously with gadolinium and appeared completely extradural [Figure -]. Based on imaging, metastasis, myeloma, and tuberculous granuloma were suspected.\nThe patient underwent standard anterior cervical decompression and fixation. Peroperatively, tumor appeared as a well-encapsulated, firm, multinodular mass, yellow tan in color, 3 cm × 3 cm × 2 cm in size. There was a small necrotic part corresponding to the T2 hyperintensity. The lesion was excised in piecemeal fashion [] to completely decompress the cord. No clue of bone was found within the mass. At this point, differential was further narrowed to granulomatous lesion like tuberculosis. Histology revealed sheets of histiocytes with foamy cytoplasm and bland nuclei. Focal cholesterol clefts and multinucleated giant cells were also noticed. There was no cellular atypia. CD68 was positive and S100 was found to be negative [Figure and ].\nThe serum calcium was normal, and lipid profile showed normolipemia. Clinical examination did not reveal any soft-tissue xanthomas. The patient was able to return to his normal activities 4 weeks after the operation. Postoperative imaging as per routine following anterior decompression and fixation consisted of plain X-ray cervical spine AP and lateral views [Figure and ]. Postoperative computed tomography (CT) of the same area was planned at the 6-month follow-up both to see the integrity of fixation as well as to rule out the tumor recurrence, but the patient was not able to reach out for imaging because of pandemic restrictions. Currently, he is 1 year out of his surgery, with no reported complaint as per telephonic follow-up.
“An 18-year-old male presented with a short history of 8 days of weakness of both lower limbs. There was no history of trauma or tuberculosis or skin lesions in form of papules or macules. No other complaint was associated and the past history was of no significance. The cranial neurological examination was normal. His Bulk, tone, and power in both upper limbs were normal. On examination of both lower limb, his bulk was normal, had bilateral spasticity with muscle power of grade 4 in all groups of muscles. His deep tendon reflexes were exaggerated with bilateral extensor plantar. No sphincter involvement and all routine investigations including lipid profile were normal. Magnetic Resonance Imaging of Spine showed mass lesion in epidural space compressing cord from behind without any bony involvement atD7 to D10 vertebral segment. Mass lesion was isointense on T1 and hyper-intense on T2 with no contrast enhancement [Figure , ].\nD7 to D10 Laminectomy with complete excision of firm epidural mass, which could be separated from dura with difficulty, was carried out. Histopathology revealed fibro-collagenous tissue with dense infiltration of lymphocytes, histiocytes, plasma cells, eosinophils, and multinucleated Touton giant cells. Histiocytic granulomas were seen. Presence of arteritis and panniculitis noted. Overall morphology was suggestive of JXG. Immune marker study was proposed and revealed Viamentin positive, Cluster Differentiation-68 positive in Touton giant cell and negative for S-100, CD1a, and Actin smooth muscle [Figure –].\nPost-operative, patient improved neurologically. His power improved to grade 5/5 with decreased spasticity. At 9 month follow-up patient had mild spasticity with extensor plantar. His MRI carried out at 3 months shows post-Laminectomy status with no residual tumor [].”