Chronic low back pain
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Chronic low back pain Rania Zeitoun 1
&
Petra Balogh 2 & Amir Amiri 3 & Alex Gibson 3 & Asif Saifuddin 4
# ISS 2019
Diagnosis Lumbar vertebral body benign notochordal cell tumor presenting as an ivory vertebra.
Discussion Benign notochordal cell tumors (BNCT) are vertebral body lesions of notochordal origin. The notochord is an embryonic midline structure that plays a pivotal role in vertebral development, contributing to formation of the nucleus pulposus. A variety of lesions of notochordal origin arise along the axial skeleton, consecutively described since the first recognition of such a lesion by Virchow in 1846, named ‘chordomata’. He was also the first who applied the term ‘physaliphorous’ in reference to the characteristic vacuolated cells [1]. By now, from the skull base to the coccyx, the following lesions can be distinguished: notochordal nests, ecchordosis physaliphora spheno-occipitalis (EP)—distinctively present at this anatomical site—and other lesions such as BNCT and chordoma [2, 3]. All lesions show identical immunoprofiles regardless of their biological behavior and are positive with epithelial markers and brachyury. The case presentation can be found at https://doi.org/10.1007/s00256019-03310-0 * Rania Zeitoun [email protected] 1
Imaging Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
2
Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
3
Spinal Surgery Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
4
Imaging Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
Under microscopic examination, BNCTs show sheets of physaliphorous cells with adipocytic-like features, lacking intercellular myxoid matrix, significant cytological atypia, mitotic activity, and necrosis. BNCT do not have the permeative growth within bone that characterizes their malignant counterpart, chordoma [4]. BNCTs are becoming more commonly recognized on imaging studies, having previously been described as intraosseous giant notochordal hamartomas, or giant notochordal rests [3, 5]. BNCTs have been found in 20% of autopsy cases, mostly involving the sacro-coccygeal vertebrae. BNCTs are typically focal lobular lesions located centrally within the vertebral body, measuring from a few millimeters up to 3.5 cm [6]. They typically show hypointense T1weighted (T1W) and hyperintense T2-weighted (T2W) and short tau inversion recovery (STIR) signal intensity (SI) on magnetic resonance imaging (MRI). They usually show corresponding mild sclerosis on radiographs and computed tomography (CT) with preserved trabecular pattern [5–7]. Unlike their malignant counterpart chordoma, BNCTs do not enhance and are not associated with osteolysis, vertebral collapse or soft tissue extension [6]. However, the coexistence of BNCT and chordoma has been described [8]. Our case demonstrated diffuse sclerosis of the L4 vertebral body on radiographs (Fig. 1) resulting in an ‘ivory vertebra’. CT confirmed diffuse me
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