PMC3012843_01
T2-weighted and gadolinium enhanced T1-weighted cervical MRI in the patient. (A) Initial cervical spine MRI (magnetic resonance image) revealed increased T2 signal from C4 to C6 level, edematous expansion of the cord and intense nodular enhancement. Based on the MRI, spinal cord tumor, demyelinating disease and acute tranverse myelitis were suspected. (B) One month later, the follow-up spinal MRI showed the extended lesion relative to previous MRI, and which highly suggested the spinal cord tumor such as intramedullay astrocytoma. (C) Demonstrates cervical spine MRI after laminectomy and tissue biopsy. (D) The patient was treated with high-dose corticosteroid and immunosuppressant for over 2 yr and spinal cord lesion was much resolved in MRI.
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F1
Initial magnetic resonance imaging (MRI) revealed increased T2 signal from C4 to C6 level, edematous expansion of the cord and intense nodular enhancement (Fig. 1A). One month later, the follow-up spinal MRI showed the more extended lesion relative to previous MRI, and which highly suggested the spinal cord tumor such as intramedullary astrocytoma (Fig. 1B). Two years later, cervical spinal cord lesion was much improved in the spinal MRI (Fig. 1D), however clinical symptoms of weakness and sensory change were not definitely improved.
Histopathology of the biopsied cervical cord lesion. (A) The specimen biopsied from the lesion contained multinucleated giant cells (red arrows), lymphocytes (black arrow) and aggregated histiocytes (white arrow) within granulomatous inflammation, consistent with non-caseating granuloma seen in sarcoidosis (H&E staining x 200). (B) The AFB staining of the specimen did not show the mycobacterium tuberculosis. PAS staining did not reveal the fungus.
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F2
Postoperatively, patient's neurologic deficits were not aggravated and, unexpectedly, the histology of biopsy revealed non-caseating granuloma without malignant cell (Fig. 2A). AFB and PAS staining of tissue were negative (Fig. 2B, C).