case_images: PMC6213809_01
case_images: MRI of the lumbar spine. (a) Sagittal postcontrast scan showing an enhancing mass at the L2-3 level. (b) Axial postcontrast scan showing a right-sided mass extending into the right neural foramen causing foraminal expansion and canal stenosis. (c) Axial T2 showing severe central stenosis
case_images: SNI-9-209-g001.jpg
case_images: PMC6213809_01_SNI-9-209-g001.jpg
case_images: F1
case_images: MRI of her lumbar spine with and without contrast showed an enhancing extradural mass at the L2-L3 level extending into the right neural foramen, contributing to severe central and right L2-L3 foraminal stenosis [Figure 1]. MRI studies of the cervical and thoracic spine were negative, as was the CT of her chest, abdomen, and pelvis.
case_images: Postoperative MRI. (a) Sagittal contrast enhancing scan showing residual tumor ventral to the thecal sac. (b) Axial contrast-enhancing scan showing residual tumor extending laterally into the neural foramen. (c) Axial T2 image showing adequate decompression of the thecal sac
case_images: SNI-9-209-g002.jpg
case_images: PMC6213809_01_SNI-9-209-g002.jpg
case_images: F2
case_images: The postoperative lumbar MRI showed the thecal sac, and neural elements at the L2-L3 level was adequately decompressed [Figure 2].
case_images: Histopathology slides. (a) Hematoxylin and eosin showing mixture of inflammation and fibrosis. (b) Hematoxylin and eosin showing areas of more extensive mononuclear inflammation. (c) CD3, numerous T-cells. (d) CD20, relatively fewer B-cells. (e) CD138, heavy plasma cells. (f) Kappa light chain. (g) Lambda light chain. (h) IgG. (i) Scale bar = 50 microns; IgG4
case_images: SNI-9-209-g003.jpg
case_images: PMC6213809_01_SNI-9-209-g003.jpg
case_images: F3
case_images: Rather, the final pathology report showed dense mixed lymphoplasmacytic and histiocytic inflammatory infiltrate with marked stromal fibrosis and a large number of IgG4+ plasma cells with an IgG4/IgG ratio of 27% [Figure 3].