case_images: PMC10559382_01
case_images: (a and b) Preoperative images - T1 pre- and postcontrast of thoracic spine and (c) one year postoperative - T1 postcontrast of thoracic spine.
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case_images: PMC10559382_01_SNI-14-333-g001.jpg
case_images: F1
case_images: There was a considerable enlargement of the spinal cord; the spinal cord with the tumor measured approximately 11 mm in the anterior-posterior dimension and 15 mm in the coronal plane. The imaging findings were concerning for a primary spinal cord neoplasm, such as an ependymoma or astrocytoma [Figure 1a]. The MRI did not show any evidence of edema or syrinx formation. A gadolinium-enhanced MRI of the thoracic spine better delineated an IMSCT partially enhancing lesion centered at T4-5 [Figure 1b]. In postoperative year 1, a gadolinium-enhanced MRI of the thoracic spine showed possible pseudo-progression [Figure 1c].
case_images: (a) 18 months postoperatively - T2 noncontrast of thoracic spine, (b) 20 months postoperatively - T1 with contrast of thoracic spine, and 3 years postoperatively showing progression (c) 3 years postoperatively - T1 with contrast of cervicothoracic spine.
case_images: SNI-14-333-g002.jpg
case_images: PMC10559382_01_SNI-14-333-g002.jpg
case_images: F2
case_images: An 18-month postoperative MRI showed slight enlargement of an intratumoral cyst, which was likely a treatment effect of the radiation therapy [Figure 2a]. Another gadolinium-enhanced MRI of the thoracic spine showed a large, enhancing nodule superior to the cystic portion of the tumor [Figure 2b]. A 2-year postoperative MRI showed a reduction in the size of the cystic component of the tumor; however, a 3-year postoperative MRI showed progression of the thoracic tumor superiorly with extension to the C7-T1 level [Figure 2c].
case_images: (a) Three years postoperatively - T1 with the contrast of cervical spine, (b) 3 years postoperatively - T1 with the contrast of lumbar spine, and (c) X-ray-guided biopsy of L4 vertebral body.
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case_images: PMC10559382_01_SNI-14-333-g003.jpg
case_images: F3
case_images: A gadolinium-enhanced MRI of the neuroaxis showed cervical extension of the disease up to the level of the clinoid [Figure 3a] and multiple enhancing lesions in the lumbosacral spine concerning metastases [Figure 3b]. Subsequently, the patient underwent a fluoroscopic-guided biopsy of the L4 vertebral body [Figure 3c].
case_images: Pathology images after open surgical biopsy and L4 vertebral biopsy. Pathology images (a) initial open surgical biopsy-hematoxylin and eosin (H&E) stain showing the slightly hypercellular glial tissue with scattered Rosenthal fibers labeled with an arrow. L4 vertebral biopsy: (b) H&E stain x4- L4 vertebral body biopsy showing glial cells embedded in bone marrow, (c) H&E stain x10-L4 vertebral body biopsy, and (d) glial fibrillary acidic protein (GFAP) stain-L4 vertebral body biopsy with the brown staining confirming glial tissue. The bone marrow is designated by "BM" in the image with the suspected glial tissue marked with the arrowhead.
case_images: SNI-14-333-g004.jpg
case_images: PMC10559382_01_SNI-14-333-g004.jpg
case_images: F4
case_images: The pathology [Figures 4a-d] showed foci of glial tissue within the bone and marrow space, confirmed with GFAP immunohistochemical stain.