55-YEAR-OLD MAN WITH A PARASPINAL MASS

摘要

A 55-year-old man presented to an outside institution for a routine preoperative chest X-ray in preparation for^knee replacement. The chest X-ray demonstrated a mass in the right lower lobe. Additional imaging with computed tomography (CT) and a positron emission tomography scan demonstrated a 1.5 cm extrapleural paraspinal mass in the region of T8, which also had mild increase in glucose uptake. Transthoracic fine needle aspirate was performed.The patient reported no history of melanoma and no change in any moles or other pigmented lesions on his skin. He was asymptomatic, with no reports of shortness of breath, chest pain, neurologic symptoms, night sweats, weight loss, nausea/vomiting, bone pain or weakness. Medical history was significant for hepatitis C and atrial fibrillation. Both parents had histories of colonic carci- noma. There was no other history of cancer in the family.Physical examination was unremarkable with no point tenderness over the thoracic spine and no sensory deficits. Neurologic examination was unremarkable. Total body skin examination failed to reveal any suspicious pigmented lesions.A magnetic resonance imaging of the thoracic spine with and without contrast demonstrated a well-defined mass in the right paraspinal soft tissue at T8 levef (Figure 1). The mass was 2.2 x 2.0 cm and demonstrated fairly homogenous contrast enhancement with extension into the adjacent right neural foramen, suggesting tumoral extension into this region. No cord compression was noted.The patient elected to have the lesion surgically removed. The surgeon noted the mass was in close connection with the exiting T8 nerve root and somewhat adherent to the sympathetic chain. The mass was separated from the pleura and other surrounding structures and removed within an intact capsule.