case_images: PMC10927179_01
case_images: Results of magnetic resonance imaging (MRI) on admission. MRI shows an intradural, longitudinally spreading spinal cord lesion in the cervical (C)7 to thoracic (Th)2 region, with gadolinium enhancement on T1-weighted imaging (WI) and diffuse swelling from the C2 to Th6 level. (a) Sagittal T2-weighted imaging. (b) Sagittal T1-weighted imaging (T1-WI) with non-contrast sequence. (c-1) Sagittal gadolinium-enhanced T1-WI. (c-2) Axial Gd-enhanced T1-WI.
case_images: SNI-15-41-g001.jpg
case_images: PMC10927179_01_SNI-15-41-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) showed a longitudinally spreading, intradural spinal cord lesion in the cervical (C)7-Th2 region, with gadolinium (Gd) enhancement on T1-weighted imaging (WI) with diffuse swelling within the C2-Th6 levels [Figure 1].
case_images: Preoperative 18F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography reveals markedly elevated uptake of FDG (white arrow) in the spinal cord (cervical7- thoracic2). (a) Coronal view. (b) Sagittal view. (c) Axial view.
case_images: SNI-15-41-g002.jpg
case_images: PMC10927179_01_SNI-15-41-g002.jpg
case_images: F2
case_images: Markedly high 18F-FDG uptake was seen on 18F-FDG-PET within the enhanced region (tumor-to-contralateral normal brain tissue ratio [TNR]: 2.52) [Figure 2], with no obvious 18F-FDG accumulation in the brain or other organs.
case_images: (a) Intraoperative photographs. (a-1) Total laminectomy (Th1-3). (a-2) The dura mater is incised to identify the spinal cord. (a-3) Gentle, blunt dissection of the posterior median sulcus is performed to locate the lesion, which does not show an obvious macroscopic margin. (b ) Histopathology of the resected tumor (b-1 and b-2) shows that large, atypical lymphocytes have extensively infiltrated the lesions. (c) The cells reveal positive staining for a cluster of differentiation (CD) 20 (d) and negative staining for CD3. Magnifications: (b-1) x100; (b-2, c, d) x400. Scale bars: (b-1) 400 microm; (b-2, c, d) 100 microm.
case_images: SNI-15-41-g003.jpg
case_images: PMC10927179_01_SNI-15-41-g003.jpg
case_images: F3
case_images: The dura mater was incised to identify the spinal cord; then, gentle blunt dissection of the posterior median sulcus was performed to locate the lesion. The lesion did not show an obvious macroscopic margin, but abnormal tissue was easily removed for biopsy [Figure 3a]. Immunohistochemical examination demonstrated a positive result for cluster of differentiation (CD)20 and a negative result for CD3, suggesting a B lymphohematopoietic system tumor, and the histological diagnosis was diffuse large B-cell lymphoma [Figures 3b-d].
case_images: (a) Sagittal T2-WI, (b) Gd-enhanced MRI and (c: coronal view; d-1,d-2,d-3: axial view) 18F-FDG-PET at 10 months after chemoradiotherapy show no residual tumor.
case_images: SNI-15-41-g004.jpg
case_images: PMC10927179_01_SNI-15-41-g004.jpg
case_images: F4
case_images: The subsequent course was uneventful, with MRI and 18F-FDGPET at ten months after completion of chemoradiotherapy, showing a complete disappearance of Gd and 18F-FDG accumulation in the spinal cord [Figure 4].