case_images: PMC11151459_01
case_images: Magnetic resonance images showing the cervical spinal cord of the present case. The extensive lesion in the second cervical (C2) spinal cord (A,B) (dotted circles) is ill-defined and heterogeneously hyperintense with loss of normal intraparenchymal architecture on sagittal (A) and transverse (D) T2-weighted images. The lesion appears iso-to-hypointense on sagittal (B) and transverse (E) T1-weighted images and iso-to-hyperintense on T2-weighted multi-echo data image combination sequence images (F). The origin of this C2 lesion cannot be determined due to its extensive distribution throughout the spinal parenchyma on all images. The lesion leads to focal spinal cord swelling and attenuation of the cerebrospinal fluid line on T2-weighted half-Fourier acquisition single-shot turbo spin-echo myelography (C), accompanied by the presence of a structure resembling the "golf-tee" sign (A) (yellow arrow) in the dorsal subarachnoid space and diffuse syringomyelia (A) (white arrow) just caudal to the lesion. Post-contrast T1-weighted sagittal (G), transverse (H), and dorsal (I) images of the cervical spinal cord. Post-contrast T1-weighted images reveal an ovoid, well-defined mass with homogeneously marked contrast enhancement. The mass contains multiple small cavities (G), suggestive of cystic or necrotic areas, leading to severe left-sided compression of the spinal cord and an appearance mimicking the "dural tail sign" of the adjacent meninges (H) (arrowhead) (H). A thickened left C2 nerve root with contrast enhancement (I) (yellow arrow), mild atrophy and contrast enhancement of the paraspinal muscle (H,I) (asterisks) adjacent to the lesion, and ventral meningeal enhancement (G) (white arrow) are also present. These findings strongly suggest a spinal tumor concurrent with gliosis and left-sided neuritis and myositis rather than inflammatory or vascular diseases. Based on these MRI findings, the mass is considered to be of intradural extramedullary rather than of intramedullary origin.
case_images: fvets-11-1400139-g001.jpg
case_images: PMC11151459_01_fvets-11-1400139-g001.jpg
case_images: fig1
case_images: T2-weighted images, ill-defined, heterogeneously hyperintense areas in the spinal cord were identified eccentrically in the central-to-left dorsal aspect of the second cervical (C2) spinal cord, leading to focal spinal cord swelling showing a loss of normal parenchymal architecture and circumferential attenuation of the cerebrospinal fluid (CSF) line on T2-weighted half-Fourier acquisition single-shot turbo spin-echo sequence (Figures 1A,C,D). The lesion appeared iso-to-hypointense on T1-weighted images and iso-to-hyperintense on T2-weighted multi-echo data image combination sequence images (Figures 1B,E,F). T1-weighted images revealed an ovoid, well-defined mass with homogeneously marked contrast enhancement (size: 10.9 x 7.2 x 8.3 mm, length/height/width; Figures 1G-I). The mass contained multiple small cavitary lesions suggestive of cystic or necrotic areas, causing severe left-sided compression of the spinal cord (Figure 1G). In the dorsal subarachnoid space just caudal to the C2 mass, although not typical, a structure resembling the "golf-tee" sign, a characteristic sign of an intradural extramedullary lesion, and syringomyelia were noted (Figure 1A). Additionally, an appearance mimicking the "dural tail sign" in the meninges adjacent to the thickened C2 left nerve root with contrast enhancement, mild atrophy with contrast enhancement of the paraspinal muscle adjacent to the lesion, and ventral meningeal enhancement were identified (Figures 1H,I).
case_images: Surgical removal of the mass following dorsal laminotomy of the axis combined with durotomy at the second cervical vertebra. (A) A bone flap (p) of the C2 axis spinous process is created with laminotomy of the C2 axis. The bone flap (p) is rotated dorsally and cranially to visualize the dorsal dura (D). (B,C) Following the laminotomy, a midline durotomy reveals a capsulated mass (asterisk). Most parts of this tumor are easily removed from the adjacent spinal cord (s) parenchyma. (D) The ventral part of the mass (asterisk) regionally adheres to the spinal cord (S) meninges (arrowhead) adjacent to the left nerve root with fibrotic tissues (hash). The ventral tumor tissues are carefully removed.
case_images: fvets-11-1400139-g002.jpg
case_images: PMC11151459_01_fvets-11-1400139-g002.jpg
case_images: fig2
case_images: A high-speed burr and bone-cutting forceps were used to create a hinged osteotomy of the C2 dorsal arch involving the cranial 75% of the C2 spinous process (Figure 2). Most tumor parts were easily separated and removed from the adjacent spinal cord parenchyma; however, the ventral part adhered locally to the spinal cord meninges adjacent to the left nerve root with fibrotic tissues (Figure 2).
case_images: Representative images of the excised mass. Gross appearance (A) and photomicrographs of histopathological evaluation (B,C). The mass is characterized by a red, well-circumscribed, and elastic appearance (A). The poorly demarcated mass is composed of neoplastic cells arranged in sheets and occasional short streams (B: 40x). The spindled, round, or polygonal cells contain small-to-moderate amounts of pale eosinophilic, wispy-to-granular cytoplasm, and heterochromatic nuclei with one or two variably distinct nucleoli (C: 400x). Anisocytosis and anisokaryosis are moderate (C). These findings are consistent with glioma, in which oligodendroglioma may be the most consistent. Scale bars in (B): 500 mum and in (C): 50 mum.
case_images: fvets-11-1400139-g003.jpg
case_images: PMC11151459_01_fvets-11-1400139-g003.jpg
case_images: fig3
case_images: The excised mass, characterized by a red, well-circumscribed, and elastic appearance (Figure 3), was histopathologically examined (hematoxylin and eosin staining). The nuclei were heterochromatic, with one or two variably distinct nucleoli, along with moderate anisocytosis and anisokaryosis (Figure 3).