case_images: PMC9275449_01
case_images: Plain and contrast enhance magnetic resonance imaging (MRI). (A) Sagittal T1-weighted MRI showed isointensive signal lesion in spinal cord at T9-10 level. (B) Sagittal T2-weighted MRI demonstrated a hyperintense signal mass. (C) Sagittal postcontrast T1-weighted MRI showed the mass was homogeneously enhanced. (D) Axial postcontrast T1-weighted MRI showed the lesion was locally connected to the nerve root. The Red arrow is mainly used to show the location of the lesion.
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case_images: PMC9275449_01_fneur-13-878414-g0001.jpg
case_images: F1
case_images: Moreover, the lower segment of the cauda equina was thickened and expanded (Figure 1).
case_images: Intra-operative image of the lesion located at the right ventral margin. (A) The lesion had abundant blood supply (the arrow); (B) The gross total resection was achieved. The Red arrow is mainly used to show the location of the lesion.
case_images: fneur-13-878414-g0002.jpg
case_images: PMC9275449_01_fneur-13-878414-g0002.jpg
case_images: F2
case_images: Therefore, the spinal cord and tumor boundary were unclear (Figure 2A). Careful separation, protection of the spinal cord, and complete microscopic resection of the tumor were performed (Figure 2B).
case_images: (A,B) The histology of the intramedullary lesion showed chronic inflammatory lymphoplasmacytic infiltrate with fibrosis, 10 x 10 magnified view showed inflammatory cell collections (Hematoxylin-eosin, magnification 100x). (C,D) 20 x 10 magnified view demonstrated chronic inflammatory infiltration (hematoxylin-eosin, magnification 200x). (E,F) 40 x 10 magnified view showed rich lymphoplasmacytic infiltrates (plasma cells, eosinophils, macrophages, and lymphocytes) with storiform arrangement of spindle cells and dense fibrosis. (G) Immunohistochemistry with plasma cells (CD38+) in the infiltration area. (H) Immunohistochemistry with plasma cells (CD138+) in the infiltration area. (I) The IgG4+ cells account for more than 50% of the plasma cells.
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case_images: PMC9275449_01_fneur-13-878414-g0003.jpg
case_images: F3
case_images: Our differential diagnoses included lymphoma, meningioma, neurilemmoma, and small cell malignancies (Figures 3A-F). The positive immunoglobulin G4 staining of plasma cells showed gross cellularity of >50/high-power field (Figure 3I) and positive CD138 staining (Figure 3H). The histiocytes showed positive CD68 staining (Figure 3G).