Tumour-like lumbar disc herniation.

To cite: Peng B, Pang X. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-009358 DESCRIPTION A 49-year-old man was admitted with right lower extremity pain and numbness that had lasted for 1 year. He had also experienced a sudden exacerbation of the symptoms for 10 days before admission. Physical examination revealed a negative straight leg raising sign in both lower extremities, weakness of the extensor hallucis longus and disappeared ankle reflex in his right lower extremity. MRI revealed a tumour-like lesion in the lumbar (L) spinal canal located between the L4–L5 and L5–S1 (L5–sacral 1) disc space levels. The lesion was encased by cystoid adipose tissue which showed high-intensity signal on the T1-weighted and T2-weighted images (figures 1 and 2). The patient underwent right L5 haemilaminectomy. A huge sequestered disc fragment was found in the epidural space, and subsequently was easily extirpated (figure 3, wet weight 30 g). An irregular rip was found in the right rear of L4–L5 disc. Further exploration found that L4–L5 disc was completely empty, which indicated that the sequestered disc fragment came from L4–L5 disc herniation. A herniated disc tissue was demonstrated by histological examination. Postoperatively, the patient had complete resolution of his right extremity symptoms over 3 months.