case_images: PMC4077786_01
case_images: X-ray of the cervical spine anterior-posterior (A) and lateral (B) views showed a mild narrowing of intervertebral disk spaces at almost every level of the cervical spine and osteoarthrosis of several apophyseal joints.
case_images: ndt-10-1175Fig1.jpg
case_images: PMC4077786_01_ndt-10-1175Fig1.jpg
case_images: f1-ndt-10-1175
case_images: Based on an assumption of cervical radiculopathy, an X-ray of the cervical spine was performed, which showed evidence of reduced normal lordosis with a mild narrowing of the intervertebral disk spaces at almost all levels of the cervical spine, with osteoarthrosis of several apophyseal joints (Figure 1).
case_images: Cervical spine magnetic resonance imaging sagittal (A) and axial views showed herniation of the intervertebral disk in C3/4 (B1), C4/5 (B2), and C5/6 (B3) shown by arrows in (A), with a compression of the ventral surface of the spinal cord.
case_images: ndt-10-1175Fig2.jpg
case_images: PMC4077786_01_ndt-10-1175Fig2.jpg
case_images: f2-ndt-10-1175
case_images: Magnetic resonance imaging (MRI) of the cervical spine revealed a minor disk bulge at C3-C4, C4-C5, and C5-C6, with posterocentral and right paramedian compression of the ventral surface of the spinal cord (Figure 2).
case_images: Axial view of brain computed tomography without contrast.. Notes: (A) Two large lobulated masses, with some calcifications in the right frontal region and in the frontal-parietal region, and with severe adjacent frontal bone hyperostosis. The T1-weighted image obtained before (B) and after (C) the intravenous administration of gadolinium, showing a homogeneous enhancement of the tumors in the high frontal area and frontal-parietal region, in suspected meningioma.
case_images: ndt-10-1175Fig3.jpg
case_images: PMC4077786_01_ndt-10-1175Fig3.jpg
case_images: f3-ndt-10-1175
case_images: Brain computed tomography was performed, revealing two large lobulated masses, with some calcifications in the right high-frontal region and another in the right frontal-parietal region and with severe adjacent frontal bone hyperostosis (Figure 3A). Brain MRI (Figure 3, B and C) with gadolinium showed two lobulated and well-defined brain tumors, one of which was in the right high-frontal area and the other in the right frontal-parietal area.
case_images: A-D Histologic findings of atypical meningiomas (World Health Organization) grade II.. Notes: (A) Composed of storiform spindle cells and plump meningothelial cells with abundant eosinophilic cytoplasm (10x10); (B) focally increased mitotic activity (arrow) (eight mitoses, ten HPF) (10x40); (C) immunohistochemical stain shows positive immunoreactivity to EMA (patchy mild-to-moderate granular membranous and cytoplasmic staining) (10x40); (D) frequent hyaline degeneration and formation of psammoma bodies (arrow), arranged in fascicles or whorl-growth patterns (10x20).. Abbreviations: HPF, high power fields; EMA, epithelial membrane antigen.
case_images: ndt-10-1175Fig4.jpg
case_images: PMC4077786_01_ndt-10-1175Fig4.jpg
case_images: f4-ndt-10-1175
case_images: The immunohistochemical stain and the pathology report were consistent with atypical meningioma, World Health Organization (WHO) grade II (Figure 4).