case_images: PMC8202386_01
case_images: Magnetic resonance imaging spine axial plane: A homogeneously enhancing intradural extramedullary mass lesion was seen at C4/5 level with extension in to the right C4 neural foramina causing widening of the foramen. The spinal cord was severely compressed and displaced to the left side
case_images: AJNS-16-159-g001.jpg
case_images: PMC8202386_01_AJNS-16-159-g001.jpg
case_images: F1
case_images: The lesion caused severe cord compression on the right side and distortion of the anatomy of the spinal cord [Figure 1].
case_images: (a and b) Intraoperative appearance of the tumor. Mark 1: Cut edge of the cervical dura. Mark 2: Dark bluish-colored tumor which is reflected laterally away from the spinal cord which lies under the cut edge of dura mater
case_images: AJNS-16-159-g002.jpg
case_images: PMC8202386_01_AJNS-16-159-g002.jpg
case_images: F2
case_images: Intraoperatively, bluish colored dumbbell-shaped extremely vascular tumor was identified along with underlying hematoma caused by a rent in the right-sided vertebral artery [Figure 2].
case_images: Microscopic appearance of the tumor: (a) (H and E x10) Heavily pigmented tumor composed of sheets of polygonal cells. (b) (H and E x40) Large vesicular nuclei and prominent nucleoli can be appreciated as places
case_images: AJNS-16-159-g003.jpg
case_images: PMC8202386_01_AJNS-16-159-g003.jpg
case_images: F3
case_images: On histology, the tumor was composed of sheets and nodules of heavily pigmented polygonal cells [Figure 3].
case_images: (a) (H and E x10) and (b) (H and E x40) Postbleach sections showing large polygonal and epithelioid tumor cells with abundant eosinophilic cytoplasm and large vesicular nuclei with prominent nucleoli
case_images: AJNS-16-159-g004.jpg
case_images: PMC8202386_01_AJNS-16-159-g004.jpg
case_images: F4
case_images: There was no significant mitotic activity or necrosis [Figure 4].
case_images: Immunohistochemistry: (a) (HMB45 x10) Tumor cells showing diffuse strong positivity for HMB45. (b) (S100 x10) Tumor cells showing diffuse positivity for S100. (c) (Mib1 x10X)- Ki 67 was very low, around 1% in tumor cells
case_images: AJNS-16-159-g005.jpg
case_images: PMC8202386_01_AJNS-16-159-g005.jpg
case_images: F5
case_images: Ki 67 index was around 1% [Figure 5].