case_images: PMC4672577_01
case_images: Axial (a) and coronal (b) T1-weighted magnetic resonance imaging showing contrast-enhancing dural-based lesion with parenchymal invasion along the right frontal lobe (arrow)
case_images: SNI-6-628-g001.jpg
case_images: PMC4672577_01_SNI-6-628-g001.jpg
case_images: F1
case_images: After 5 years of no radiographic evidence of residual disease, a routine follow-up magnetic resonance imaging (MRI) scan at 6 years revealed an enhancing dural lesion over the right frontal lobes [Figure 1].
case_images: Axial (a), coronal (b), and sagittal (c) T1-weighted magnetic resonance imaging showing contrast-enhancing dural-based lesions through the frontal sinus and along the falx cerebri (a), right temporal lobe (b), and right sphenoid wing (c) (arrows)
case_images: SNI-6-628-g002.jpg
case_images: PMC4672577_01_SNI-6-628-g002.jpg
case_images: F2
case_images: His follow-up MRIs approximately every 6 months remained negative until additional dural-based lesions along the frontal sinus, right temporal lobe, and right sphenoid wing were observed at 3 years [Figure 2].
case_images: PMC4672577_02
case_images: Axial (a) and sagittal (b) T1-weighted magnetic resonance imaging showing a contrast-enhancing sinonasal mass with intracranial extension through the cribriform plate into the anterior cranial fossa, maxillary, and sphenoid sinuses
case_images: SNI-6-628-g003.jpg
case_images: PMC4672577_02_SNI-6-628-g003.jpg
case_images: F3
case_images: A 48-year-old woman presented with a large sinonasal mass with extensive intracranial extension through the cribriform plate into the anterior cranial fossa [Figure 3].
case_images: Sagittal T1-weighted magnetic resonance imaging showing contrast-enhancing dural-based lesions posterior to C2 vertebral body (a), posterior to T9-T10 disc space (b), and along the posterolateral dura at the L3-L4 level (c) (arrows)
case_images: SNI-6-628-g004.jpg
case_images: PMC4672577_02_SNI-6-628-g004.jpg
case_images: F4
case_images: Spinal imaging revealed multiple dural-based enhancing lesions in the cervical, thoracic, and lumbar spine with possible osseous involvement, consistent with drop metastasis [Figure 4].
case_images: Photomicrographs from spinal mass at T9-10. H and E staining shows well-defined clusters of cells separated by a fibrovascular stroma (a). Higher magnification (b) shows small, round cells with large nuclei and scant cytoplasm. Immunohistochemical staining for synaptophysin, a neuronal cell marker, is strongly positive in all lesional cells (c) and is completely within the cytoplasm (d). Staining for CD45 (e), a lymphoid tissue marker, and cytokeratin, a marker for adenocarcinoma, were both negative. Magnification: (a and c) x2, (b, d-f) x40
case_images: SNI-6-628-g005.jpg
case_images: PMC4672577_02_SNI-6-628-g005.jpg
case_images: F5
case_images: Pathological analysis of both lesions affirmed a diagnosis of recurrent esthesioneuroblastoma with leptomeningeal spread [Figure 5].