case_images: PMC3271631_01
case_images: MRI of lumbosacral spine (1A-D) revealed a very well circumscribed intradural extramedullary T1 hyperintense (A, a), T2 isointense (1B,b) lesion at the level of S1 and S2 with scalloping of the posterior border of these two vertebrae; along with chemical shift artefact on gradient imaging (1C); There was no enhancement on post-contrast fat saturated T1W images (1D). MRI of both the calves (1E) revealed enlargement of right calf with involvement of soleus and medial head of gastrocnemius with fatty replacement of muscle tissue.
case_images: JNRP-3-89-g002.jpg
case_images: PMC3271631_01_JNRP-3-89-g002.jpg
case_images: F1
case_images: T2 isointense [Figure 1B] lesion at the level of body of S1 and S2 with scalloping of the posterior border of these two vertebrae. The cord was tethered, and ended at S2. There was no enhancement on postcontrast fat saturated T1W images [Figure 1D]. The imaging features were suggestive of lipoma. MRI of both the calves revealed enlargement of gastrocnemius and thigh muscles with fatty replacement of muscle tissue [Figure 1E].
case_images: Muscle biopsy from right gastrocnemius revealed myopathic features with prominent myophagocytosis (arrow, A) and regeneration. Note presence of eosinophils in the infiltrate. In addition, neurogenic features with atrophic fibres with clumped myonuclei (arrow, B) and adipose tissue infiltration is also noted. (a: H and E, x120, b: H and E, x40)
case_images: JNRP-3-89-g003.jpg
case_images: PMC3271631_01_JNRP-3-89-g003.jpg
case_images: F2
case_images: Biopsy of the enlarged right gastrocnemius muscle revealed infiltration of adipose tissue splaying apart the myofibres [Figure 2b]. In addition, myopathic features with scattered fibers showing myophagocytosis and regeneration [Figure 2a] and focal interstitial inflammation was present close to aponeurosis with histiocytes and eosinophils.