The patient went on to have a cervical decompression.

Histology

Sections show sheets of tumor cells containing pale eosinophilic cytoplasm, oval hyperchromatic nuclei and prominent nucleoli. Focal tumor necrosis is present. Frequent mitoses are observed.

Immunohistochemical results show tumor cells stain: POSITIVE: CKAE1/3, CK7, TTF1. NEGATIVE: CAM5.2, CK20, p40, CD68, S100, Tyrosinase, CD1a, CD79a, CD138, PSA, Thyroglobulin, Calcitonin. The Ki67 proliferation index is approximately 70%.

FINAL DIAGNOSIS: Cervical epidural mass: poorly differentiated carcinoma, most consistent with lung primary.

Discussion

It is not always trivial to distinguish metastatic disease from infection. In this instance, involvement of two adjacent vertebrae with involvement of the lateral disc does raise the possibility of infection. The CT scan of the chest was obtained after cervical decompression.