Chondrosarcoma Apoplexy in Thoracic Spine
A 52-year-old man was admitted to the emergency room with sudden paraplegia. Twelve hours prior to such paraplegic event, he visited an outpatient clinic. At that time, he just complained of discomfort and tenderness around the medial border of the right scapular, and his neurologic statue was absolutely intact. He had no special past medical history. As such, he wanted to make another visit later when he would develop aggravated pain. There was no evidence of increased uptake on the PET-CT scan that he has checked two years ago. Magnetic resonance imaging (MRI) checked at the emergency room showed a lobulated soft tissue mass from T3 to T5, which extended to the epidural space (). Computed tomography scans showed soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures (). Emergent surgery was performed, and the lesion was removed. Dark reddish blood and gel-like material were encountered around the dura and posterior arch during the operation. The histologic examination showed findings conformed to dedifferentiated chondrosarcoma (). The results of immunohistochemical stains for the high grade spindle cells were focal (+) for smooth muscle actin antibody, but (-) for desmin, cytokeratin, CD34 and S-100 protein. Multiple pulmonary nodules were found on chest CT scan, and biopsy of one of them had proven to be a metastasis of chondrosarcoma. The patient's neurologic deficit was improved slowly from ASIA A to ASIA D.