Differential Considerations : Include Giant Cell Tumor , Lymphoma

[light7]

My son is  a 35 year old male , diabetic , Thoratic spine W/O and W/Contrast. with all MRI'S
2004 found lesion
2006 no changes
May 2007 Findings :
There is an abnormal  signal within T3. There is also abnormal  enhancement in the vertabrael body and adjacent paravertebral and epidural regions, including the neural foramen. There is also enhancement in the epidural region, neural foramen and paravertabrael areas T2 AND T4. The overall enhancement has not significantly changed.
However there is a mass just underneath the right pedicle of T3 that measures 1.6 cm in diameter. There is a slight mass effect on the right posterolateral aspect of the thecal sac, but ther is no significant central canal stenosis or spinal compression.
The thoratic vertebral body  heights and alignment are maintained.  Thers is no central canal or neural foraminal stenosis.
  Impression : Abnormal signal and enhancemet within T3 and in the surrounding soft tissues from T2 Inferiorly through T4. There is a more prominent portion of the lesion just underneath the right pedicle of the T3 that has increased in size from prior exam in 2006.
The orthopedic oncoligist says that  my son  should have a En Block Resection and he should have it done within the next 2 weeks because of the  tumor can cause damage to the lungs and spine.

What is your opinion on this procedure ?  

Thank you .
Light

[Joanna Fong, MD]

Hi light7,

From the MRI report that you posted above, it seems that your son has enhancing lesion in the thoracic region.  Enhancement of the those areas (vertabrael body, adjacent paravertebral and epidural regions, including the neural foramen, neural foramen and paravertabrael areas T2 AND T4) meaning that those lesions are likely to be active, allowing the contrast material to penetrate into that affected areas, thus what we call enhancement.  Since I don't know the primary etiology or pathophysiology of the tumor, it's hard for me to tell you whether these lesions are from malignant or benign tumor.  Because of the locations of the tumor, it can spread to adjacent areas, such as the lungs and spinal cord.  In that case, taking the tumor out is indicated.  I would go seek neurosurgery/orthopaedic spine recommendation regarding the procedure.  To see whether or not the tumor has spread to other area, you can have CT chest (for lungs involvement) and MRI spine (for spinal cord involvement) for diagnosis.  Also, monitor for any new symptoms that would suggest spreading of the disease.  Lung cancer would typically presents with coughs (bloody), shortness of breaths,etc.  Spinal cord involvement would typically presents with new numbness or tingling sensations over your body and legs (if it's thoracic regions) and weakness.  In those cases, seek medical attention immediately.

Good luck.

THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY.  PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.

[mike1105]

I woulod run to the Mayo in Rochester Minnesota. you can wait in the lobby as a walk-in. It may take a few days or even a week or 2 of waiting but it is one of the best medical facilities in the country. that or the cleveland clinic in cleveland

[JonM]

Get a 2nd opinion from another oncologist.  If your in the US and have Insurance it is customary and most if not all Ins Cos. will pay.  Try to get referred to a University teaching hospital if at all possible.

[light7]

I should mention they are sending my son for a ct scan of the lungs Thursday and then he sees another   Orthopedic  doctor on Friday . This is at the Strong U of R hospital.

He also has an appointment with his primary doctor this week , to discuss current findings..

Thank you for  taking the time to reply .
Light