case_images: PMC11747408_01
case_images: The sagittal MRI images from the patient's initial consultation. A space-occupying lesion was observed within the intra dural extramedullary space from the 11th thoracic vertebra to the 1st lumbar vertebra, with clear borders and compression at the spinal cord level of the 12th thoracic vertebra, as indicated by the arrow. The lesion appears isointense on T1-weighted imaging (A), while on T2-weighted imaging (B), it predominantly shows slightly higher intensity, with punctate high signals within. There is marked enhancement observed on the contrast-enhanced scan (C). No significant abnormal signals were observed elsewhere in the spinal canal.
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case_images: The lesion appears isointense on T1-weighted imaging ( Figure 1A ), while on T2-weighted imaging ( Figure 1B ), it predominantly shows slightly higher intensity, with punctate high signals within. There is marked enhancement observed on the contrast-enhanced scan ( Figure 1C ).
case_images: (Intraspinal, Thoracic 11 - Lumbar 1) Sarcomatoid Carcinoma. (A) Hematoxylin and eosin (HE) stained section showing tumor composed of epithelial and mesenchymal components. The carcinoma component is a poorly differentiated squamous cell carcinoma with keratinization, marked with green triangle symbols in the image. The sarcomatoid component is an undifferentiated sarcoma, exhibiting spindle-shaped and epithelioid morphology with pleomorphism, indicated by white arrowheads in the image. (B, C) depict immunohistochemical stained sections. The carcinoma component shows positive expression of P40 and CK5/6, while the mesenchymal component is negative for P40 and CK5/6.
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case_images: Postoperative pathology revealed intraspinal carcinosarcoma from T11 to T12 ( Figure 2 ), containing both epithelial and mesenchymal components.
case_images: Initial MRI scan of the patient upon first examination at our hospital, showing patchy signal changes in the Th11-12 surgical area and adjacent soft tissues, with significant enhancement on contrast-enhanced scans (A). Following the first round of radiotherapy, the signal changes have slightly decreased compared to before, with reduced enhancement on subsequent scans (B). Two months later, MRI indicated an increase in the nodular lesion at T12, with invasion into the spinal cord (C). The sagittal view showed the appearance of multiple new small nodules indicating intramedullary dissemination within the spinal cord (D).
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case_images: MRI indicated postoperative changes at T11-12, with soft tissue enhancement in the surgical area suggestive of residual tumor ( Figure 3A ). Follow-up MRI, conducted 10 days later, revealed a reduction in soft tissue enhancement in the surgical area, suggesting effective radiotherapy ( Figure 3B ). T12, with invasion into the spinal cord ( Figure 3C ). The sagittal view showed the appearance of multiple new small nodules indicating intramedullary dissemination within the spinal canal ( Figure 3D ).
case_images: The sagittal view of the radiation therapy target areas for the patient. The target area for the patient's first round of radiation therapy is defined as the region where tumor remnants are visible on imaging (A). During the initial 10 sessions of the second round of radiation therapy, the target area encompasses the entire central nervous system (B). In the subsequent 10 sessions of the second round of radiation therapy, the target area excludes the Gross Tumor Volume (GTV) delineated during the first round of therapy and is limited to the brain and some segments of the spinal cord (C).
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case_images: The prescribed dose was PGTV 44.0 Gy in 22fractions ( Figure 4A ). Figure 4B ). For the subsequent 10 sessions, CTV excluded the GTV from the first course, focusing on the brain and part of the spinal cord ( Figure 4C ).