Abstract
Case Presentation
A 61-year-old male initially presented with right sided weakness and dysarthria. He underwent stroke workup which showed C3-5 anterior vertebral mass. Despite proper cervical precautions, the patient’s exam deteriorated to complete quadriparesis during transfer to a tertiary center for neurosurgical evaluation. Shortly after arrival, he required intubation for paradoxical breathing. MRI of the cervical spine demonstrated a large mass involving the C3–C5 vertebral bodies with extension into the paravertebral and epidural spaces, resulting in vertebral body retrolisthesis and spinal cord compression. Following goals of care discussion, comfort measures were ultimately pursued (Figure 1). Autopsy performed showed a lytic, necrotic, tan-gray, 7.0 cm cervical spine mass. Pathology showed poorly differentiated chondrosarcoma – the third most common primary malignant bone tumor after myeloma and osteosarcoma (Figure 2). These tumors are slow-growing, rarely metastasize, and arise from cartilage.
1
CT imaging and autopsy were negative for metastasis from another source, suggesting this to be the primary site. MRI cervical spine (sagittal T2) shows a large predominantly necrotic mass involving the C3–C5 vertebrae and posterior elements with erosive destruction and marked prevertebral extension(red arrow). Retrolisthesis causes severe canal stenosis with cord edema(blue arrow). Mild epidural extension extends C3–C6 Gross images of cervical mass from autopsy specimen. Note petechial hemorrhages within the cord suggestive of more severe cord compression
Footnotes
Ethical Considerations
All authors contributed equally to this manuscript. The authors obtained Institutional Review Board approval for retrospective case review (West Virginia University, IRB ID STUDY00000195). No informed consent was required.
Consent to Participate
The authors obtained Institutional Review Board approval for retrospective case review. No informed consent was required.
Authors Contributions
Nikolas Toksoy: drafting manuscript
Matthew Smith: drafting and revision
Nathaniel Mohney: drafting and revision
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this author.