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case_images: Intraspinal tumor on cervical magnetic resonance imaging (MRI) of a 32-year-old man. A, MRI images on admission. (A1) T1W1, (A2) T2W1. B, MRI images after tumor incision biopsy, partial excision, and tracheostomy. (B1) T1W1, (B2) T2W1. Arrows indicate an intraspinal tumor.
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case_images: T2WI and low signal on T1WI; Fig. 1A). The patient had an unremarkable medical history and no familial history of spinal tumors. A tumor incision biopsy with partial excision and a tracheostomy was carried out on day 10, as contrast cervical MRI showed an intraspinal tumor (Fig. 1B).
case_images: Summary of the clinical course of a 32-year-old man with grade IV glioma.
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case_images: We switched from sulbactam/ampicillin for ventilation-associated pneumonia to meropenem and daptomycin for septic shock (Fig. 2).
case_images: Pathology of the intraspinal tumor of a 32-year-old man. A1, A2, Hematoxylin-eosin (HE) stained specimens of the glioma. A2 is an expanded view of the area within the square in A1; it is difficult to differentiate the tumor cells. Scale bar = 50 microm. B1, B2, Glioma was immunostained for histone 3 (K27M mutant-specific) in the biopsy section. B2 is an expanded view of the area within the square in B1. Immune-positive (brown-stained) cells indicate glioma cells. Scale bar = 50 microm.
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case_images: Histopathological examination showed diffuse invasion of glioma cells in the normal parenchyma, and histone H3-K27M mutations showed positive nuclear staining with the anti-H3-K27M antibody (Fig. 3). Health Organization grade IV glioma, "diffuse midline glioma H3 K27M-mutant" (Fig. 3). We provided chemoradiotherapy under mechanical ventilation in the intensive care unit, which is the standard treatment for this tumor type. He received 50 Gy radiotherapy in 25 fractions on days 28-66, and was transferred to the general ward on day 35 and to another hospital for subacute care.