case_images: PMC11225424_01
case_images: (a) The orange dotted arrow exhibits a cystic conus medullaris tumor on a sagittal T2 magnetic resonance imaging (MRI) between T12 and L1 with an underlying nodular lesion. (b) Axial T1 gadolinium MRI between T12 and L1 shows a small posterior left mural nodule around the cystic cavity, advocating for a possible spinal hemangioblastoma (yellow arrow). (c) Sagittal T1 gadolinium MRI shows a homogeneous contrast enhancement of the cauda equina tumor (orange arrow) between L1 and L2.
case_images: SNI-15-187-g001.jpg
case_images: PMC11225424_01_SNI-15-187-g001.jpg
case_images: F1
case_images: The cystic portion grew rapidly while the mural nodule stayed stable in size [Figure 1].
case_images: PMC11225424_02
case_images: PMC11225424_03
case_images: PMC11225424_04
case_images: Postoperative magnetic resonance imaging (MRI) performed at 3 months after surgery demonstrating complete resection of both cauda equina and conus medullaris lesions. (a and b) Left image shows a sagittal T2 conus medullaris hypersignal without any signs of residual disease (no contrast enhancement) on T1 gadolinium imaging. MRI showed no signs of recurrent cauda equina myxopapillary ependymoma.
case_images: SNI-15-187-g002.jpg
case_images: PMC11225424_04_SNI-15-187-g002.jpg
case_images: F2
case_images: Immediate and 3 months postoperative magnetic resonance imaging (MRI) confirmed complete resection of both lesions without any complications [Figure 2].
case_images: (a) Microscopic examination with hematoxylin and eosin (H&E) (H&E staining) shows multiple small capillary cavities of a hemangioblastoma (HB), (b) demonstrates the positive immunoreactivity of alpha inhibin in HB, (c ) shows diffuse positive CD34 markings of numerous vessels (black dotted-arrow) from a World Health Organization grade 1 HB, and (d) under microscopic magnification 400 with H&E, tumor cells are arranged radially around a central vessel (blue arrow), a typical histological feature of myxopapillary ependymomas (i.e., perivascular pseudo rosettes).
case_images: SNI-15-187-g003.jpg
case_images: PMC11225424_04_SNI-15-187-g003.jpg
case_images: F3
case_images: Microscopic examination of hematoxylin and eosin of the sample of the conus medullaris tumor showed proliferation made of a double contingent of stromal cells with regularly rounded nuclei, clear micro vacuolated cytoplasm, and a vascular contingent made of a multitude of small capillary cavity [Figure 3a]. The immunohistochemical study confirmed the diagnosis of HB (the World Health Organization [WHO] grade 1) with positive immunoreactivity for PS100, epidermal growth factor receptor, alpha inhibin [Figure 3b], brachyury (cytoplasmic expression) toward the stromal component, and positivity of vessels toward CD34 [Figure 3c]. CD34 marked some vascular structures [Figure 3d].