J Korean Neurosurg Soc.  2012 Jan;51(1):54-58. 10.3340/jkns.2012.51.1.54.

Solitary Xanthogranuloma of the Upper Cervical Spine in a Male Adult

• Lee SJ
• Jo DJ
• Lee SH
• Kim SM

• KMID: 2190475
• DOI: http://doi.org/10.3340/jkns.2012.51.1.54

Abstract

We present the rare case of solitary xanthogranuloma in the upper cervical column mimicking a Brown-Sequard syndrome. A 29-year-old man complained with right hemiparesis and left hypoesthesia after a car accident. Computed tomography and magnetic resonance images revealed a lobulated homogenously well-enhancing mass in between posterior arch of the atlas (C1) and spinous process of the axis (C2) resulting in a marked spinal canal narrowing with cortical erosions. The patient was managed by complete resection of the tumor with partial laminectomy with lower half of C1 posterior arch and upper half of C2 spinous process. The authors advise complete removal of the xanthogranuloma and consideration as a differential diagnosis of lesions among upper cervical lesions.

Keyword

Juvenile xanthogranuloma; Xanthogranuloma; Cervical vertebrae; Brown-Sequard syndrome

MeSH Terms

Adult
Axis, Cervical Vertebra
Brown-Sequard Syndrome
Cervical Vertebrae
Diagnosis, Differential
Female
Humans
Hypesthesia
Laminectomy
Magnetic Resonance Spectroscopy
Male
Paresis
Spinal Canal
Spine
Xanthogranuloma, Juvenile

Figure

• 

  Fig. 1 Preoperative MRI showing abnormal signal intensities on epidural dumbbell-shaped mass (measuring 25×18×24 mm) traversing the C1 to C2 interspinous space, compressing surrounding structures. The dumbbell-shaped lesion reveals isointense on sagittal T1-WI (A), mixed hypointense on T2-WI (B), and well-enhanced after gadolinium administration (C). The spinal cord was compressed at the C2 level, and the signal change appeared on T2-WI. MRI : magnetic resonance images, WI : weighted image.

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  Fig. 2 Post-operative CT scan. Partial hemilaminectomy, from the lower half of the C1 posterior arch to upper half of C2 spinous process, was performed (A : mid-sagittal, B : 3-dimensional reconstruction). C : Follow-up MRI with enhancement after postoperative 2 years reveals no residual and no recurrence. CT : computed tomography, MRI : magnetic resonance images.

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  Fig. 3 Photomicrographs of the tumor reveals focal aggregation of cells with ample, clear, and foamy cytoplasm. There are large round cells with irregular vesicular nuclei. H&E, original magnification ×200.

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  Fig. 4 Gross finding of the tumor. A : External surface of the tumor; ovoid, yellowish, encapsulated with a white-colored adhesion scar at the mid-portion of the mass shown in the picture. B : Mid-section of the tumor, particularly yellow and white with cystic components.

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