Virtual Microscope
A 53 year-old man with compression fracture in lumbar spine
Kar-Ming Fung, M.D., Ph.D.
Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Last updated: July 19, 2006
Clinical Information: The patient was a 53 year-old male smoker who lived in Philadelphia metropolitan area. He presented with low back pain lower extremity numbness. A CT scan demonstrated compression fracture of the body of L4/L5 associated with a soft tissue mass that bulged into the spinal canal and compressed the spinal cord. Osteolytic lesions were also noted in L3 and S1. On chest plain film, there was mild lymphadenopathy in the mediastinum. The pre-operative diagnosis included metastatic carcinoma, particularly small cell carcinoma from the lung, metastatic prostatic carcinoma, and other metastatic carcinoma as well as infections. A laminectomy with decompression was performed. The following is virtual microscopic of the soft tissue mass that compresses the spinal cord.
Diagnosis: Tuberculoma (tuberculosis of the spine or Pott's disease).
Pathology: Tuberculosis of the spine or tuberculous spondylitis, also known as Pott's disease was named after Sir Percivall Pott, the English surgeon who described this condition in a monograph published in 1779. The salient features are tubeculosis leading to compression fracture of the spine. This condition typically results from hematogeneous spread of tuberculosis from other sites particularly the lung. When the infection from two adjacent vertebrae spread into the share adjoining disc space, the disc will be damaged. Compression fracture and bulging of the intervertebral disc follows.
In geographic areas where tuberculosis is common, Pott's disease are often seen in children. In geographic areas where tuberculosis is rather uncommon, its manifestations often deviates from the typical or classic clinical setting. Tuberculosis and other infection of the spine such as blastomycosis should not be forgotten.