case_images: PMC9918856_01
case_images: Preoperative MRI evaluation.. Preoperative axial T1-weighted (A) and axial T2-weighted (B) MRI scans showing an extradural lesion compressing the nerve root L4. Contrast-enhanced T1 weighted sagittal (C) and axial (D) MRI scans demonstrates homogenous enhancement of the lesion. As differential diagnosis other pathologies such as lymphoma, leucaemic infiltration, plasmocytoma, and metastasis of an unknown primary tumor were considered.
case_images: cureus-0015-00000033677-i01.jpg
case_images: PMC9918856_01_cureus-0015-00000033677-i01.jpg
case_images: FIG1
case_images: The dumbbell-shaped, smooth lesion had an isointense signal on T1-weighted images and was hyperintense on PD and T2-weighted images (Figure 1A, 1B). T1 images was observed (Figure 1C, 1D). These findings were preoperatively interpreted as a lymphoma rather than a disc herniation. 
case_images: Results of histopathological examination.. Microsections show a tissue composed of tightly packed collection of variably thickened and hyalinized, dilated blood-filled vessels. The blood vessel walls are thin and consist of endothelium and a collagenous adventitia lacking elastic tissue (A: HE, 100x; B: EvG, 100x; C: EvG, 100x; D: EvG, 100x).
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case_images: PMC9918856_01_cureus-0015-00000033677-i02.jpg
case_images: FIG2
case_images: The blood vessel walls consisted of endothelium and a collagenous adventitia lacking elastic tissue and with little smooth muscle cell component, as shown on EvG-stained sections (Figure 2).
case_images: Postoperative radiological findings.. Six months postoperative T1-weighted contrast enhanced sagittal (A) and axial (B) as well as T2-weighted sagittal (C) and axial (D) MRI scans demonstrated completely resection of the lesion and radicular decompression.
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case_images: PMC9918856_01_cureus-0015-00000033677-i03.jpg
case_images: FIG3
case_images: The follow-up MRI and CT six months after surgery showed complete resection of the lesion with no signs of radicular compression (Figure 3). 