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Case Reports
. 2023 Apr;13(4):37-40.
doi: 10.13107/jocr.2023.v13.i04.3606.

Mass: The Conundrum in Spine

P D Rath  1 , Sunil Katoch  2 , Abhijeet Kumar Agrawal  1 , Swetal Chouhan  1 , H N Bajaj  3 , Rahul Bisaralli  1
Affiliations
Case Reports

Mass: The Conundrum in Spine

P D Rath et al. J Orthop Case Rep. 2023 Apr.

Abstract

Introduction: Immunoglobulin (Ig)G4-related disease belongs to a rare compilation of conditions in rheumatology and may involve a multitude of organs. Amidst the central nervous system (CNS) presentation, involvement of spinal cord is rarer still.

Case report: Case 1: A 50-year-old male came with chief complaints of tingling sensation over both soles since 2 months associated with lower back ache and gait disturbance in the form of spastic gait. X-rays of spine were suggestive of a growth at the level of D10-D12 compressing the spinal cord with no focal sclerotic/lytic lesions, and MRI dorsolumbar spine showed dural tail sign. The patient underwent excision of dural mass, and histopathology revealed majority of plasma cells positive for IgG4. Case 2: A 65-year-old female came with complaints of cough, shortness of breath, and fever on and off since 2 months. No history of hemoptysis, purulent sputum, weight loss. On examination: There were bilateral rhonchi in the left upper zone. MRI spine showed focal erosion with soft-tissue thickening at the right paravertebral region extending from D5-9. The patient underwent surgery (fusion D6-8 and ostectomy D7 posterior rib resection D7 right side) with the right pleural biopsy and transpendicular intracorporal biopsy D7. Histopathology was compatible with findings of IgG4 disease.

Conclusion: IgG4 tumors presenting in CNS itself is rare and rarer in spinal cord. Histopathological examination is central to diagnose and prognosticate the disease further as IgG4-related disease manifestations may recur without proper treatment.

Keywords: IgG4; central nervous system; pleura; spinal mass.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Growth at D10–D12 level.
Figure 2
Figure 2
(a) Intraoperative image and (b) resected tumor.
Figure 3
Figure 3
Focal erosion involving right side of vertebral body and sheet like signals – pleura thickening at the right paravertebral region. (a) MRI – sagittal view and (b) positron emission tomography–computed tomography image showing mass infiltrating pleura and vertebra.
Figure 4
Figure 4
(a) Intraoperative image and (b) post-operative image.
See this image and copyright information in PMC

References

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