case_images: PMC11756385_01
case_images: MRI of the spine (A) sagittal T1-weighted fat-saturated post-contrast image and (B) sagittal Short Tau Inversion Recovery (STIR) sequence demonstrating multiple intra-spinal, extra-medullary meningeal-based enhancing lesions. The largest lesion measures 22 x 11 mm at the D4 level.
case_images: rjaf022f1.jpg
case_images: PMC11756385_01_rjaf022f1.jpg
case_images: f1
case_images: MRI identified dorsal intraspinal enhancing soft tissue lesions indenting the spinal cord (Fig. 1), consistent with dural-based metastases.
case_images: MRI of the brain (A) coronal T1 pre-contrast and (B) coronal T1 post-contrast images showing multiple leptomeningeal enhancing nodules. The largest are seen at the left frontal parafalcine region (as shown in the single arrow) and bilateral sylvian fissures (as shown in the two arrows).
case_images: rjaf022f2.jpg
case_images: PMC11756385_01_rjaf022f2.jpg
case_images: f2
case_images: Months later, persistent back pain led to further imaging, which revealed progressive intradural lesions and new extra-axial meningeal nodular lesions likely representing meningeal deposits (Fig. 2).
case_images: Histopathological examination showing (A) prominent PD-L1 expression, (B) high power of tumor cell infiltration, (C) P63 expression, (D) malignant epithelial cell infiltration of desmoplastic stroma.
case_images: rjaf022f3.jpg
case_images: PMC11756385_01_rjaf022f3.jpg
case_images: f3
case_images: Despite the absence of recurrent nasopharyngeal mass, biopsy of the spinal lesions confirmed metastatic NPC (Fig. 3), indicating disease progression despite an initial excellent response to treatment.