Introduction: Pigmented villonodular synovitis (PVNS) of the spine is a rare condition, with only a limited number of cases documented in the medical literature. In this study, we review imaging findings of two cases of PVNS arising in the spine. Case 1: A 52-year-old male presented with right thigh pain of unclear etiology. His condition subsequently deteriorated and he was referred to our hospital. MRI revealed a spinal tumor with high intensity on T1-weighted imaging (T1WI) and iso-intensity on T2WI in the right L2/3 intervertebral foramen. The tumor exhibited heterogeneous enhancement on contrast-enhanced MRI. Computed tomography (CT) myelography showed the presence of an epidural tumor within the right L2/3 intervertebral foramen, situated externally to the spinal canal and compressing the dura mater. Notable scalloping was observed in the posterior margin of the L2 vertebral body on CT images. Case 2: A 78-year-old male presented with a complaint of muscle weakness of the left upper limb. His gait gradually deteriorated, which led to suspicion of cervical myelopathy. A tumor was observed on plain MRI and exhibited low to iso-intensity on T1WI and high intensity on T2WI. The tumor was in the left C7/T1 intervertebral segment and the spinal cord was compressed from the left side. CT showed destruction of the medial aspect of the left C7 vertebral arch. Conclusion: In spinal PVNS, the signal intensity on MRI is dependent on the timing of hemorrhage within the tumor, and there are no distinctive features. However, if an extradural tumor is suspected and CT shows bone erosion, scalloping or osteolytic changes, PVNS should be considered as a differential diagnosis.
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