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case_images: Fig. (1-a) T2 weighted brachial plexus MRI coronal cut. Fig. (1-b) T2 weighted brachial plexus MRI coronal cut. Fig. (1-c) T2 weighted brachial plexus MRI axial cut. Fig. (1-d) T2-weighted short-tau inversion recovery (STIR) brachial plexus MRI axial cut. Showing smooth thickening, hyperintense signal on fluid sensitive images and diffuse postcontrast enhancement involving C5 and to lesser extent C6 spinal roots, extending to the upper trunks, divisions, lateral and posterior cords of the right brachial plexus (red arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: The report concluded that these observations may be indicative of neuritis associated with radiation treatment, emphasizing the need for clinical correlation and subsequent follow-up scans Fig. 1.
case_images: Fig. (2-a) T2 weighted brachial plexus MRI coronal cut. Fig. (2-b) T1 weighted STIR brachial plexus MRI coronal cut. Fig. (2-c) T1 weighted STIR cervical spine MRI axial cut. Fig. (2-d) T2 weighted cervical spine MRI axial cut showing progression of the thickening with lobulated appearances involving the nerve roots at C4-C5 and C5-C6 levels on the right side with brachial plexus involvement and intraspinal extension medially best appreciated at the level of the C4-C5 neural foramina (red arrow) resulting in mass effect upon at the corresponding portion of the spinal cord and cord displacement to the left side. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: As a result, these concluded as a strong indication for the presence of a metastatic process involving the nerves Fig. 2.
case_images: Histopathologic examination revealed alternating hypocellular (A) and hypercellular areas (B) (H&E 10x), (C) spindle cells with hyperchromatic thin wavy nuclei, prominent mitotic activity (arrow head) (H&E 40x). (D) The tumor cells are positive for CD56. (E) S100 is negative. (F) H3K27me3 immunostain shows loss of nuclear staining in the tumor cells in the presence of positive internal control.
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case_images: This immunostain has good sensitivity and robust specificity for the diagnosis of MPNST, further supporting the diagnosis in this case Fig. 3.
case_images: Fig. (4-a) T2 weighted cervical spine MRI sagittal cut showing. Fig. (4-b) T2 weighted cervical spine MRI axial cut showing mass extension along C3-C4 right exit foramen and a new epidural mass measuring 2.9 x 1.5 cm in length along C3 and C4 levels. The mass is causing compression upon the spinal cord at this level.
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case_images: A cervical spine MRI was performed, revealing a recurrence of the lesion at the C3 and C4 levels, causing compression of the spinal cord Fig. 4.