Lateral radiograph of thoraco-lumbar spine showed only a mild area of osteolysis in T12 vertebral body (Fig.1),
without osteosclerotic rim,
bulging of the cortex or visible calcifications inside.
CT scan,
aimed to the thoracolumbar stretch,
demonstrated a mild dense area in the posterior half of the T12 vertebral body,
partially sclerotic,
with lobulated and regular edges,
involving the posterior wall and the right pedicle (Fig.2a,
2b),
showing moderate post-contrast enhancement (Fig.2c).
The lesion was mainly well defined .
MR imaging of the whole spine showed low-intense lesion on T1-weighted images localized in T12 vertebral body (Fig.
3a),
showing very high signal intensity on T2-weighted images (Fig.
3b),
and mild post-contrast enhancement (Fig.
3c).
Moreover,
3 other thoracic localizations were detected (T4,
T5,
and T7 vertebrae),
presenting exactly the same characteristics of the main lesion in T12 vertebra.
At first,
they were indicative of metastasis,
but their MR behaviour leaded to better identify them as localization of the same tissue (Fig.4).
Therefore,
the pathology,
presumably benign,
has been considered multicentric.
Finally,
in order to resolve the diagnostic doubt,
the patient underwent CT guided biopsy and the result of hystologic exam was BNCT (Fig.5).
BNCT cells typically show intraosseous sheets of adipocyte-like vacuolated chordoid cells,
intermingled with less vacuolated eosinophilic cells of various degrees,
without any myxoid background.
Some colloid-like material is contained in cystic spaces.
The nuclei are usually bland,
without any mitotic figures.
The affected bone trabeculae are sclerotic because of appositional or reactive new bone formation.
The following MR imaging examination performed during the last two months showed the stability of the lesions,
supporting the diagnosis of BNCT.