The patient is a boy, 14 years old, who presented to this hospital in November, 1997 with history of cervical pain related to effort for 3 months. He had only partial relief with anti-inflammatory medications. He denied vomiting, fever or any infectious or neurologic symptoms. The patient had no relevant previous medical history and had experienced normal development.
The physical examination revealed no neurologic sign or any other clinical finding.
All blood studies were normal.
Fre ´derique Nugues, MD (Pediatric Radiologist)
Cervical radiography was performed and showed degeneration of the C3 vertebra; i.e., ''vertebra plana.'' Magnetic resonance imaging (MRI) of the affected bone was obtained immediately following radiography and it showed an aggressive infiltrating tumor in C3 with an extension to the posterior half of the vertebra and into the soft tissues (Fig. 1).
This osteolytic lesion of the cervical spine in a child might be due to Langerhans cell histiocytosis. Since this boy was already 14 years old, other diagnoses also come to mind including aneurysmal bone cyst, and such primary bone tumors as telangiectatic osteosarcoma, osteoblastoma, and giant cell tumor (GCT) of bone.
Dr. Michalowski
After this initial evaluation, surgery was indicated to provide an exact diagnosis and prevent further bony disintegration. Our patient was then submitted to a surgical intervention that included a total resection of the body of C3 with autologous bone graft and cementing from C2-C4 anteriorly. The tumor tissue was dark brown and very hemorrhagic. The possibility of a wider excision was restricted by neurologic and vascular limitations. The patient presented no post-surgical complications.