case_images: PMC11225512_01
case_images: (a-1, a-2) Computed tomography (CT) without contrast enhancement shows no abnormal masses, but marked ventricular enlargement. Preoperative (b-1, b-2, b-3) axial fluid-attenuated inversion recovery and (c-1, c-2, c-3) gadolinium (Gd)-enhanced T1-weighted imaging (WI) on MRI reveal multiple intracranial areas of abnormal intensity.
case_images: SNI-15-221-g001.jpg
case_images: PMC11225512_01_SNI-15-221-g001.jpg
case_images: F1
case_images: Intracranial computed tomography revealed marked ventricular enlargement [Figure 1a], leading to urgent ventricular drainage. Magnetic resonance imaging (MRI) demonstrated multiple lesions at various sites in the CNS, including the spinal cord, appearing hypointense on T1-weighted imaging (WI) and hyperintense on T2-WI and fluid-attenuated inversion recovery imaging, with strong enhancement on T1-WI using gadolinium contrast [Figures 1b and c, 2a].
case_images: (a-1, a-2) Magnetic resonance imaging (MRI) demonstrates a longitudinally extending intradural lesion within the spinal cord with Gd enhancement on T1-WI. On 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), abnormally high uptakes are evident in the (b-1, b-2, b-3, b-4) cranial and (c) spinal region, representing the same sites identified on MRI.
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case_images: PMC11225512_01_SNI-15-221-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) demonstrated multiple lesions at various sites in the CNS, including the spinal cord, appearing hypointense on T1-weighted imaging (WI) and hyperintense on T2-WI and fluid-attenuated inversion recovery imaging, with strong enhancement on T1-WI using gadolinium contrast [Figures 1b and c, 2a]. CNS [Figure 2b and c]. Cerebrospinal fluid (CSF) analysis showed a slightly elevated cell count (6/muL) and highly elevated protein (153 mg/dL).
case_images: Histopathology of the biopsy specimen. Hematoxylin and eosin staining show a fascicular arrangement of oval cells with eosinophilic cytoplasm and tumor cells with pleomorphic nuclei and prominent nucleoli. Mitotic figures are elevated, and scattered necrotic foci are apparent. (a) Magnification, x40; scale bar, 500 mum. (b) Magnification, x200; scale bar, 100 mum. (c and d) Magnification, x400; scale bar, 250 mum.
case_images: SNI-15-221-g003.jpg
case_images: PMC11225512_01_SNI-15-221-g003.jpg
case_images: F3
case_images: Postoperative histopathology obtained using hematoxylin and eosin (HE) staining demonstrated a highly cellular area comprising oval and round cells with eosinophilic cytoplasm [Figure 3a-d].
case_images: Photomicrographs revealing the tumor histopathology. (a)Immunohistochemically, tumor cells are negative for the glial marker glial fibrillary acidic protein (GFAP). Negative results are obtained for (b) smooth muscle antigen, but (c) myogenin, and (d) desmin are positive. Immunohistochemical studies also show negative results for (e) S-100 and (f) integrase interactor 1, excluding the diagnoses of malignant peripheral sheath tumor and atypical teratoid/rhabdoid tumor (AT/RT). Magnification, x400; scale bar, 100 mum.
case_images: SNI-15-221-g004.jpg
case_images: PMC11225512_01_SNI-15-221-g004.jpg
case_images: F4
case_images: Moreover, an immunohistochemical study showed negativity for S-100 and integrase interactor 1, excluding the diagnoses of malignant peripheral sheath tumor and atypical teratoid/rhabdoid tumor [Figure 4a-f].