case_images: PMC4765242_01
case_images: Coronal, sagittal, and axial T2-weighted contrast-enhanced magnetic resonance imaging of the spine that revealed a contrast-enhancement of two nodular formations, one in the L4 nerve root and the second distally in the right lateral recess of the spinal canal (a). After 6 months, the lumbar magnetic resonance imaging showed that a tumor of the nerve root had grown (b)
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case_images: PMC4765242_01_SNI-7-108-g001.jpg
case_images: F1
case_images: He had undergone coronal, sagittal, and axial T2-weighted contrast-enhanced magnetic resonance imaging (MRI) of the lumbar spine that revealed a contrast enhancement of two nodular formations placed in the L4 nerve root, the first located proximally, measuring 1.1 cm x 0.6 cm, and the second distally in the right lateral recess of the spinal canal, measuring 2.1 cm x 0.9 cm [Figure 1a]. The lumbar MRI showed that a tumor of the nerve root had grown [Figure 1b].
case_images: The brain and cervical spine magnetic resonance imaging were normal at the first investigation (a). After 7 months sagittal T1-weighted contrast-enhanced magnetic resonance imaging of brain and spine demonstrated a hypertensive hydrocephalus, leptomeningeal enhancement, and contrast-enhanced masses throughout the cervicothoracic spinal cord surfaces (b)
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case_images: PMC4765242_01_SNI-7-108-g002.jpg
case_images: F2
case_images: The brain and cervical spine MRI were normal [Figure 2a]. T1-weighted contrast-enhanced MRI of brain and spine demonstrated a hypertensive hydrocephalus, leptomeningeal enhancement, and contrast-enhanced masses throughout the cervicothoracic spinal cord surfaces [Figure 2b]. The patient underwent urgent cervical decompression via C7-T2 laminectomy with partial resection of the fibrous tumor and a ventricular catheter to monitor intracranial pressure and CSF drainage.
case_images: After the incision of the dura mater, a fusiform tumor was visualized adjacent to the L5 foramen and resected with clear margins
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case_images: F3
case_images: The entire segment of L4 nerve root was resected with clear margins [Figure 3].
case_images: The anatomopathological and immunohistochemical study showed a hypercellular malignant spindle cell tumor with a high mitotic index and moderate pleomorphism in a nerve root, compatible with a malignant peripheral nerve sheath tumor
case_images: SNI-7-108-g004.jpg
case_images: PMC4765242_01_SNI-7-108-g004.jpg
case_images: F4
case_images: The anatomopathological and immunohistochemical studies showed a hypercellular malignant spindle cell tumor with a high mitotic index and moderate pleomorphism in a nerve root, compatible with a malignant peripheral nerve sheath tumor (MPNST) [Figure 4].