Clinical question: 62-year-old female with metastatic Phyllodes tumor to spine. Signs and symptoms: Back pain. Non-enhanced CT lumbar spine:Examination demonstrate a large destructive lytic lesion involving the vertebral body of L5 on the right with involvement and extension across the right pedicle into the right facet complex and transverse process of L5 vertebrae. The overall length of this lesion measures 56-mm in transverse axis and 37-mm in AP axis. This lesion also partially involve the right lamina. There is partial extra osseous extension of tumor into the right neural foramina at L5 -- S1 and minimally at L4 -- L5. There is no distinct evidence of extension of mass into the spinal canal. For detailed evaluation an MRI is significantly more sensitive for detection of extent of tumor. Minimal bulge of disk, degenerative change and vacuum phenomenon of L4 -- L5 disk is noted. The a small additional separate foci of low-attenuation in the left paramedian of L5 vertebrae is also present. This finding also could represent a small additional metastatic lesion and measures 7-mm times 11-mm in size. Minimal sclerotic changes along the inferior endplate of L2 is believed to be secondary to degenerative changes. No additional lytic or sclerotic metastatic lesions are identified. The alignment of the lumbosacral spine remains within normal.CT of cervical spine:A large lytic / sclerotic destructive bony lesion is noted involving the left aspect of vertebral body of C6 with involvement of left transverse process, pedicle, facet complex and left lamina. The overall transverse axis of this tumor measures 34-mm and 22.5-mm in AP axis. There is small extra osseous spread of tumor into the left paraspinal space. There is shallow epidural spread of tumor along the ventral aspect of the canal on the left and along the lamina on the left. This tumor also appears to involve the left foramina transversarium. The normal alignment of vertebral column is maintained. A very small entirely intraosseous a foci of low density within the anterior aspect of body of C4 vertebrae may also in indicate a second metastatic foci. This lesion measures on the 3.5 x 2.5-mm in size.
1.Large destructive lytic metastatic lesions of vertebral bodis, pedicles, transverse process and lamina of C6 and L5 as detailed above. There is a small extra osseous spread of tumor into the soft tissues of cervical spine and epidural space of the lumbar spine. Please see above detailed report.2.Possible two very small entirely intraosseous additional metastatic foci.3.The alignment of vertebral column and cervical and lumbosacral spine remains within normal.