30-year-old man with 5-month history of pain in the lumbar area, buttock, and right leg. 30-year-old man with 5-month history of pain in the lumbar area,

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Presentation transcript:

30-year-old man with 5-month history of pain in the lumbar area, buttock, and right leg. 30-year-old man with 5-month history of pain in the lumbar area, buttock, and right leg. A–C, Sagittal T1-weighted (500/10/3 [TR/TE/excitations]) (A) and T2-weighted (4200/100/3) (B) MR images through the L3–L4 level (C) show an ovoid lesion in the mid-posterior spinal canal at L3–L4 (arrow) causing moderate central spinal stenosis. Lesion is largely hyperintense on T1- and T2-weighted images and has a hypointense rim on T2-weighted sequences. There is bilateral facet joint degenerative change at this level but the lesion is not contiguous with the facet joint. A developmentally small spinal canal and disk degenerative change at L4–L5 and L5–S1 are also noted. (The disk herniation was left paracentral on axial images through L5–S1 [not shown]).D–F, Histopathologic sections.D, Degenerative debris at top is surrounded by a cellular reaction including giant cells (arrow) (hematoxylin-eosin, original magnification ×190).E, Disrupted elastic tissue (arrow) of the ligamentum flavum is seen in one of the zones peripheral to the hemorrhagic debris. Although from a different microscopic field, the orientation is similar to that in D, with the hemorrhagic debris in the upper portion of the photo (elastic trichrome, original magnification ×190).F, Amyloid is seen within a giant cell (arrow). An adjacent section stained for elastic tissue showed fragments of elastica within a giant cell at this site, suggesting intracellular co-localization of amyloid and elastica fragments in some giant cells (Congo red, original magnification ×380). Houman Mahallati et al. AJNR Am J Neuroradiol 1999;20:1166-1168 ©1999 by American Society of Neuroradiology