case_images: PMC11131339_01
case_images: Magnetic resonance imaging of the spine.. (A) Post-contrast T1-weighted sagittal image of initial tumor. (B) T1 Dixon sagittal image of recurrent tumor (12 years later) with extramedullary extradural soft tissue mass between C7 and T1. (C) Post-contrast T1-weighted axial image of initial tumor. (D) STIR sagittal image of recurrent tumor.
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case_images: PMC11131339_01_ICNS_A_2336796_F0001_C.jpg
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case_images: Subsequent radiographic images demonstrated a lesion centered at the right T3-T4 neural foramen (Figure 1 A & C). Unfortunately, 10 years after the initial diagnosis, routine full-spine imaging was concerning for neoplasm recurrence (Figure 1B & D). T1 raised concern for recurrence (Figure 1). The tissue from the biopsy had histological characteristics of ependymoma.
case_images: The patient's atypical teratoid rhabdoid tumor (AT/RT) on histology.. H&E sections demonstrate a malignant neoplasm characterized by cells with vesicular chromatin and visible nucleoli in both the initial resection and the re-resection (A, C). Immunohistochemistry for BAF47 (INI1) shows loss of expression in tumor cells in both the initial resection (B) and the re-resection (D). Immunohistochemistry performed on the re-resection was positive for vimentin (E), smooth muscle actin (F), and EMA (G). PDL-1 (22C3) performed on the re-resection was positive in approximately 30% of neoplastic cells (H).
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case_images: PMC11131339_01_ICNS_A_2336796_F0002_C.jpg
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case_images: However, the patient underwent subsequent maximal safe resection and further pathological analyses demonstrated loss of nuclear staining for INI1/BAF47 (Figure 2).