Spinal Epidural Synovial Sarcoma: A Case of Homogeneous Enhancing Large Paravertebral Mass on MR Imaging
Sang-il Suha,
Hae Young Seola,
Suk-Joo Honga,
Joo Han Kimb,
Jong Hyun Kimb,
Ju Han Leec and
Myung Gyu Kimd
a Medical Research Center and Departments of Radiology
b Neurosurgery
c Pathology, Guro Hospital, Korea University School of Medicine, Seoul, South Korea
d Korea MS Diagnostic Radiology Clinic, Guro-Ku, Seoul, South Korea
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FIG 1. A 44-year-old man with right low back pain.
T1-weighted (A, -B) (TR/TE/acquisition, 716/13/2) and T2-weighted (C) (TR/TE/acquisition, 4000/114/2) axial MR images show a large mass (asterisks) in the right paravertebral space at the L4-L5 level. It is isointense to muscle with T1 weighting (A, -B) and isointense to subcutaneous fat and hyperintense to muscle with T2 weighting (C). The mass infiltrates the adjacent structures (arrowheads) with focal erosion of the superior articular process of L5 (arrow). Ipsilateral neural foraminal widening and displacement of the thecal sac due to the epidural component are also demonstrated. Contrast-enhanced T1-weighted (D) (TR/TE/acquisition, 716/13/2) axial MR images reveal moderate homogeneous enhancement of the mass.
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FIG 2. Histologic evaluation of low-grade biphasic synovial sarcoma involving the right paravertebral area with neural foraminal and spinal epidural extension.
A, The spindle cells of the tumor are uniform and relatively small, with ovoid pale-staining nuclei and inconspicuous nucleoli (hematoxylin and eosin, original magnification x400).
B, The epithelial cells of the tumor have ovoid nuclei and abundant cytoplasm. They form glands with lumen (asterisks) (hematoxylin and eosin, original magnification x400).
C, Immunohistochemistry for cytokeratin demonstrates the epithelial components of the tumor (arrows) (cytokeratin [AE1/AE3], ABC method, original magnification x200).
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