case_images: PMC8247701_01
case_images: (a and b) AP and lateral radiographs showing thoracolumbar instrumentation. As well as distal junctional deformity. (c) Expansion of the sacrum; (c) localized sacrum shows narrowing and remodeling of the walls of sacrum.
case_images: SNI-12-285-g001.jpg
case_images: PMC8247701_01_SNI-12-285-g001.jpg
case_images: F1
case_images: T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
case_images: (a) T1-weighted sagittal MRI showing an isointense expansile mass in the sacrum; (b and c) T2-weighted sagittal and axial MRI shows a hyperintense mass with small isointense patches. Screws in L1 and T11 vertebral bodies are seen (white narrow arrows).
case_images: SNI-12-285-g002.jpg
case_images: PMC8247701_01_SNI-12-285-g002.jpg
case_images: F2
case_images: T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
case_images: Sacral reconstructed C.T. (a) Sagittal images showing expansion of the sacrum, (b) coronal images note enlargement of the sacral foramina.
case_images: SNI-12-285-g003.jpg
case_images: PMC8247701_01_SNI-12-285-g003.jpg
case_images: F3
case_images: T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
case_images: Intraoperative photographs: (a) note protrusion of the tumor from the enlarged sacral foramina (white arrow heads).
case_images: SNI-12-285-g004.jpg
case_images: PMC8247701_01_SNI-12-285-g004.jpg
case_images: F4
case_images: The patient underwent a sacral laminectomy for gross total tumor removal [Figure 4].
case_images: (a) H-E 200 staining shows the cells arranged around vascular core containing blood vessels or pseudorosettes (black arrows), typical for MPE. (b) H-E higher magnification shows cells with anaplasia (black arrow heads), (c) note the tumor cells are diffusely reactive with glial fibrillary acidic protein, and (d) diffusely positive for S100 staining.
case_images: SNI-12-285-g005.jpg
case_images: PMC8247701_01_SNI-12-285-g005.jpg
case_images: F5
case_images: Histology and immunohistochemical studies were confirmatory for an anaplastic MPE; the latter findings included; glial fibrillary acidic protein and S100 staining findings consistent with MPE [Figure 5].
case_images: At 1-year follow-up, (a) T1-weighted sagittal MRI, small tumor recurrence in the sacrum.
case_images: SNI-12-285-g006.jpg
case_images: PMC8247701_01_SNI-12-285-g006.jpg
case_images: F6
case_images: One year later, the patient had a follow-up sacral MRI scan that documented small residual/recurrent focal tumor [Figures 6 and 7]. She continued to exhibit residual incomplete saddle sensory deficit with urinary dysfunction requiring intermittent catheterization; otherwise she had no other new focal neurological deficits [Figure 6].
case_images: (a and b) Total spinal AP and lateral radiographs show persistent distal junctional disease (add-on) with no change in its degree. (c) Photograph of the patient with no apparent deformity.
case_images: SNI-12-285-g007.jpg
case_images: PMC8247701_01_SNI-12-285-g007.jpg
case_images: F7
case_images: One year later, the patient had a follow-up sacral MRI scan that documented small residual/recurrent focal tumor [Figures 6 and 7].