Male, 43 years old, history of metastatic renal cancer to C1, with neck pain. The right occipital condyle is infiltrated and expanded by enhancing tumor, and this lesion may be slightly increased in size from prior. A subcentimeter tumor deposit is also seen within the left basiocciput. A very large tumor deposit is evident centered on the left lateral mass of C1 with involvement of the anterior and posterior arches. This lesion extends medially to encroach upon the left lateral thecal sac, as well as into the left C1-2 neural foramen. A substantial lateral paraspinal component is also seen which infiltrates the prevertebral and paraspinal muscles causing a leftward deviation of the carotid space. This lesion measures up to 48 x 31 mm in the axial plane, previously measuring up to 37 x 22 mm. Although there is effacement of the left lateral thecal sac, tumor does not contact or impinge upon the spinal cord and there is no significant spinal canal stenosis.Tumor infiltration of the C4 vertebral body is demonstrated without evidence of significant extraosseous spread or loss of vertebral body height. This lesion is probably new or larger from the prior exam.A small area of tumor infiltration is suspected within the right aspect of the C5 vertebral body, and again within the right aspect of the C7 vertebral body. Both are new or larger from the prior exam. Tumor infiltration is also evident along the proximal left T2 rib which appears similar to prior.A nonenhancing, potentially cystic nodule, within the left posterior subcutaneous neck is unchanged. Mild pharyngeal edema and tracking fluid is seen, perhaps reactive to bulky C1 tumor.Spinal alignment is anatomic. Vertebral body heights are preserved. Disc osteophyte complexes are seen at C5-6, with mild spinal canal stenosis and moderate right foraminal narrowing, and at C6-7 with minimal spinal canal stenosis. Uncovertebral hypertrophy on the right is demonstrated at C3-4.
Progression of metastatic disease with large growing tumor deposits involving the right occipital condyle and the left lateral mass of C1. The C1 lesion causes mild encroachment upon the left lateral spinal canal but no significant canal stenosis or cord impingement.Scattered smaller tumor deposits throughout the cervical spine may also be new or increased in size, but these are confined to the marrow space.Tumor encasing the proximal left second rib appears unchanged. A nodule in the posterior subcutaneous tissues of the neck is unchanged and may be benign.