We present a case of a 45-year-old man who was admitted to hospital in February 2017 due to right shoulder pain for 1 month, increased pain accompanied by right little finger and ring finger numbness, and radiating pain for half a month. The patient had no family history, genetic history or history of psycho-social disease. No relevant treatment measures were taken in this patient before.
General medical examination revealed no fever and no special signs and symptoms. The skin temperature and skin color of patient’s right neck was normal, no obvious vascular manifestations were seen on the surface. There was no obvious pain when pressing the lesion and the right upper extremity blood circulation, sensation and movement were good. Physiological reflexes were normal and pathological reflexes were not elicited.
Computed tomography (CT) scan revealed multiple cystic bone destruction areas in C6–7 vertebral right part and appendage with marginal osteosclerosis and surrounded by soft tissue density. The size of the lesion was about 36 mm × 41 mm (Fig. 1). Magnetic Resonance Imaging (MRI) features were shown as follows: (a). The margin of the lesion appears lobulated. (b). Lesion showed slightly hypointense on T1-weighted image (T1WI), slightly hyperintense on T2-weighted image (T2WI) and slightly hyperintense on Short tau inversion recovery (STIR). (c) Multiple patchy T1WI hyposignals and T2WI hypersignals were seen within the lesion. (d). No enhancement was observed in the lesion after injection of contrast, and there was no abnormal signal in surrounding soft tissue and bone (Fig. 2).
Preoperative laboratory tests were normal as follows: routine blood test, electrolyte test, urine analysis, blood coagulation test, erythrocyte sedimentation rate, fasting plasma glucose, and cardiac enzymes were negative. Laboratory tests of tumor markers were normal as follows: Alpha fetoprotein (AFP): 2.78 ng/ml (normal range: 0–7.00 ng/ml), Carcinoembryonic antigen (CEA): 2.82 ng/ml (normal range: 0–5.00 ng/ml), Carbohydrate antigen 19-9 (CA19-9): 10.73 U/ml (normal range: 0–30.00 U/ml), Total prostate specific antigen (tPSA): 1.79 ng/ml (normal range: 0–4.00 ng/ml), Carbohydrate antigen 72-4 (CA72-4): 3.76 U/ml (normal range: 0–6.90 U/ml), and Neuron specific enolase (NSE): 10.50 ng/ml (normal range: 0–16.30 ng/ml).
Histopathological section of cervical tumor (posterior resection specimen) showed fibromuscular tissue with myxoid degeneration, in which lumen like structures of variable size and uneven thickness are visible (Fig. 3). S-100 protein (partial+), cluster of differentiation 34 (CD34) (+), and erythroblast transformation-specific regulated gene-1 (ERG) (+) were tested positive, and cytokeratin (CK) (−) and epithelial membrane antigen (EMA) (−) were negative in immunohistochemical findings. Special staining results: elastic fibers (−).
Combined with the results of blood biochemical tests, clinical manifestations, imaging data and immunohistochemical tests, the pathological morphology could be consistent with lymphangioma with extensive myxoid degeneration.
After over 2 years of follow-up, there were no signs of disease recurrence and progression. Patient had no right shoulder pain, no right little finger and ring finger numbness.