case_images: PMC10481863_01
case_images: The initial brain magnetic resonance imaging showing a large intrinsic mass located from the medulla oblongata to the upper cervical cord. The tumor appeared uniformly hypointense on the T1-weighted image (a) and hyperintense on the T2-weighted image (b) with heterogeneous enhancement (c).
case_images: SNI-14-299-g001.jpg
case_images: PMC10481863_01_SNI-14-299-g001.jpg
case_images: F1
case_images: T1-weighted image and hyperintense on the T2-weighted image with heterogeneous enhancement [Figure 1]. To establish the histological diagnosis and achieve decompression of the craniovertebral junction, the patient underwent tumor biopsy with suboccipital craniotomy.
case_images: Histopathology showing dense small cells with atypical nuclei and eosinophilic process (a). No microvascular proliferation or necrosis was observed. Glial fibrillary acidic protein (GFAP) was positive (b) and the MIB-1 labeling index was high at 18.9% (c).
case_images: SNI-14-299-g002.jpg
case_images: PMC10481863_01_SNI-14-299-g002.jpg
case_images: F2
case_images: Small cells proliferated densely, nuclei were unevenly distributed, and eosinophilic protrusions were observed [Figure 2].
case_images: (a and b) Head computed tomography at 4 days after starting chemotherapy demonstrated marked enlargement of tumor.
case_images: SNI-14-299-g003.jpg
case_images: PMC10481863_01_SNI-14-299-g003.jpg
case_images: F3
case_images: However, the left-sided hemiparesis progressed on the 1st day of chemotherapy, and computed tomography showed an increase in tumor size [Figure 3].
case_images: Magnetic resonance imaging at 9 months of age after the treatment completion showed a decrease in the size of the cervicomedullary tumor with hyperintensity on the T2-weighted image.
case_images: SNI-14-299-g004.jpg
case_images: PMC10481863_01_SNI-14-299-g004.jpg
case_images: F4
case_images: The tumor markedly decreased at the follow-up MRI at 15 months of age [Figure 4].