case_images: PMC10864138_01
case_images: Gadolinium (Gd)-enhanced sagittal lumbar spine MRI (July 2022) (A) of an intradural mass (2.5 cm in diameter) at the L4 level with well-homogeneous enhancement, which occupied the whole spinal canal at this level. Gd-enhanced whole-spine MRI of other masses at the cervical and thoracic spines (B). The tumor showed histological features with irregularly formed vessels interspersed with large stromal cells (C; H&E, x100). The tumor cells were slightly positive for alpha-inhibin (D; immunohistochemistry, x200) but strongly positive for EGFR (E; x200).
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case_images: F1
case_images: Gadolinium (Gd)-enhanced lumbar spine MRI showed an intradural mass (2.5 cm in diameter) at the L4 level (Fig. 1A). Additional whole-spine MRI showed multiple small masses at the cervical and thoracic spines (Fig. 1B). HB. Histopathologically, the tumor exhibited analogous histological features, showing irregularly formed vessels interspersed with large stromal cells exhibiting hyperchromatic nuclei (Fig. 1C). Notably, the tumor cells exhibited limited immunopositivity for alpha-inhibin (Fig. 1D) but demonstrated robust immunopositivity for epidermal growth factor receptor (EGFR) (Fig. 1E).
case_images: Gadolinium-enhanced axial brain MRI (December 2000) of an intraventricular mass (4 cm in diameter) at the third and lateral ventricles.
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case_images: F2
case_images: In December 2000 (22 years ago), the patient had undergone craniotomy and a subtotal removal of a large solid tumor in the third ventricle extending to the lateral ventricles (Fig. 2).
case_images: Gadolinium-enhanced axial brain MRIs (April 2014) of the tumors in the cerebellomedullary cistern (A) and fourth ventricle (B).
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case_images: F3
case_images: At 14 years after the brain surgery, Gd-enhanced axial brain MRIs (April 2014) showed two newly developed tumors in the cerebellomedullary cistern (Fig. 3A) and fourth ventricle (Fig. 3B).
case_images: The tumor exhibited irregularly dilated blood vessels and extensive hemorrhage at low magnification (A; H&E staining, original magnification x40). At high magnification, the tumor had vacuolated stromal cells characterized by large hyperchromatic nuclei and an eosinophilic foamy cytoplasm (B; H&E, x200).
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case_images: F4
case_images: Microscopic examination at low magnification revealed irregularly dilated blood vessels and extensive hemorrhage (Fig. 4A). Upon closer inspection at high magnification, vacuolated stromal cells characterized by large hyperchromatic nuclei and an eosinophilic foamy cytoplasm were identified amidst well-developed blood vessels (Fig. 4B).
case_images: Gadolinium (Gd)-enhanced sagittal spine MRI (January 2023) of a progressed 2 cm-sized vividly enhancing intramedullary mass at the T9 level (A), and Gd-enhanced axial brain MRI (May 2023) of the tumor in the right cerebellopontine angle (B). Histopathologically, the second recurrent brain tumor was composed of plump tumor cells characterized by a clear cytoplasm (C; H&E, x100) with immunopositivity for alpha-inhibin (D; x200) and EGFR (E; x200).
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case_images: F5
case_images: T9 level demonstrated a severe mass effect on the spinal cord (Fig. 5A). Three months after the second spinal surgery (May 2023), the patient underwent suboccipital craniotomy due to the progression of the tumor in the right cerebellopontine angle (Fig. 5B). In the subsequent recurrence, there were prominent tumor cells characterized by a clear cytoplasm and delicate fibrovascular septae (Fig. 5C). Immunohistochemical analysis revealed positive staining for alpha-inhibin (Fig. 5D) and EGFR (Fig. 5E).