Case report 768

A 29-year -o ld m a n presen ted with a 3 -month h i s to ry o f increas ing pa in and stiffness o f the neck. There was a decrease in range o f m o t i o n u p o n f lexion and extens ion o f the neck bu t no neuro log ica l deficits were noted . P la in r a d i o g r a p h s o f the cervical spine were o b t a i n e d and revealed an expand ing lesion involv ing the spinous process o f C2 (Fig. 1). The rest o f the cervical spine was normal . C o m p u t e d t o m o g r a p h y (CT) o f this reg ion was p e r f o r m e d and conf i rmed a lytic des t ruc t ive lesion involv ing the sp inous process o f C2 wi th irregu la r i ty o f c o n t o u r and an assoc ia ted soft t issue mass (Fig. 2). The l amina o f C2 was pa r t i a l ly involved. Par t i a l des t ruc t ion o f the sp inous process o f C3 was also seen due to the enc r o a c h m e n t o f the mass at C2. A p reope ra t i ve w o r k u p for exc is ional b iopsy o f the lesion i n c l u d e d a n o r m a l bone survey. A bone scan showed an a rea o f increased u p t a k e in the p r o x i m a l e n d o f the r ight t ibia. R a d i o g r a p h s o f the t ib ia a t the site o f t ake -up were negat ive and the pat ient was a s y m p t o m a t i c at this locat ion.