case_images: PMC10064394_01
case_images: a Coronal T2: A T2 hyperintense mass widening the right L4-L5 neural foramen and scalloping the posterior aspect of the L4 vertebral body, extending into the right paraspinal soft tissues including the psoas musculature. b Sagittal STIR: there is edema in the posterior aspect of L4 vertebral body as well as the right posterior elements. c Axial T2: hyperintense mass widening the right L4-L5 neural foramen and scalloping the posterior aspect of the L4 vertebral body, extending into the right paraspinal soft tissues including the psoas musculature. d Post-contrast axial T1 shows marked enhancement in the lesion.
case_images: pne-0058-0029-g01.jpg
case_images: PMC10064394_01_pne-0058-0029-g01.jpg
case_images: F1
case_images: T2/STIR hyperintense, lobulated, heterogeneous enhancing lesion widening the right L4-L5 neuronal foramen with scalloping of the posterior right L4 vertebral body and extending into the paraspinal soft tissues, most suggestive of a right L4 peripheral nerve sheath tumor (shown in Fig. 1). There were no obvious signs of periosteal involvement.
case_images: a Coronal T2: decompression of the right L4-L5 neural foramen, scalloping of the posterior aspect of the L4 vertebral body still present, no apparent residual tumor in the right paraspinal soft tissues and the psoas musculature is intact. b Sagittal STIR: slight reduction in edema in the posterior aspect of L4 vertebral body as well as the right posterior elements. c Axial T2: complete resection of the mass but widening the right L4-L5 neural foramen and scalloping the posterior aspect of the L4 vertebral body is still present, no residual mass seen in the right paraspinal soft tissues including the psoas musculature. d Post-contrast axial T1 shows no enhancement in the area where the lesion was indicating gross total resection.
case_images: pne-0058-0029-g02.jpg
case_images: PMC10064394_01_pne-0058-0029-g02.jpg
case_images: F2
case_images: We dissected the mass from the L4 nerve root with great difficulty and followed it down to the vertebral body, achieving a gross total resection (confirmed on postoperative imaging, shown in Fig. 2).
case_images: a Section of the tumor shows lobular pattern of short cords of eosinophilic epithelioid cells impeded in a myxoid stroma (H and E, x40 magnification). b Section of the tumor highlights the physaliphorous cells along with the epithelioid tumor cells (H and E, x400 magnification). c The neoplastic cells show immunoreactivity for pan-cytokeratin (x400 magnification). d The neoplastic cells show diffuse and strong nuclear staining for brachyury (x400 magnification).
case_images: pne-0058-0029-g03.jpg
case_images: PMC10064394_01_pne-0058-0029-g03.jpg
case_images: F3
case_images: These features are shown in Figure 3.