PMC5234272_01
Magnetic resonance images from the original patient presentation in 2007. (a) Preoperatively, axial T1-weighted contrast images demonstrated a mass lesion located along the right tentorium, extending toward the temporal lobe and the pons. (b) Postoperative T1-weighted contrast image. A tumor invading into the cavernous sinus (arrow) remained. The extent of resection was judged as "subtotal"
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F1
She had an intracranial tumor originating from her right tentorium and underwent subtotal surgical resection [Figure 1].
Magnetic resonance images from 2013 when the patient was referred back to us with a recurrent intracranial lesion. (a) Axial T1-weighted image of the brain, demonstrating a recurrent mass lesion (arrow). (b, c) Sagittal T1-weighted images demonstrating spinal disseminated lesions (arrowheads). The tumor at T11/12 (arrow) did not cause thoracic myelopathy at that time
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F2
In 2013, the patient was referred back to us with a recurrent intracranial lesion [Figure 2]. However, spine MRI demonstrated disseminated lesions along the spinal cord, which were compatible with intraspinal dissemination [Figure 2].
Preoperative magnetic resonance images of the spinal cord. (a, b) Sagittal T1-weighted images with gadolinium, demonstrating intraspinal disseminated lesions that were increased in size (arrowheads). Note the T11/12 lesion (arrow in B) compressing the spinal cord. (c) Axial T1-weighted contrast image demonstrating the T11/12 tumor now causing a deformity of the spinal cord. (d) Sagittal T2-weighted image demonstrating an abnormal hyperintense area in the dorsal spinal cord where the T11/12 lesion is located (arrow)
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F3
MRI demonstrated enlargement of multiple intraspinal lesions spanning the spinal cord [Figure 3].
Intraoperative photographs following left T11 hemilaminectomy. (a) Following the dural opening, a mass lesion was visible underneath the arachnoid membrane (arrow). (b) Subtotal surgical resection was performed. A layer of the tumor was left attached to the dorsal spinal cord (arrow). Note that the left and right sides of the images were the rostral and caudal sides, respectively
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F4
Importantly, the tumor was located in the subarachnoid space and was tightly adherent to the spinal cord surface [Figure 4].
Histological examination of the tumor cells with hematoxylin and eosin staining, the findings of which were compatible with the diagnosis of hemangiopericytoma. Scale bar = 100 mum
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F5
Pathological evaluations demonstrated a hypercellular tumor with numerous slit-like vascular channels called staghorn sinusoids [Figure 5].
Follow-up magnetic resonance images 16 months after resection. (a) Axial T1-weighted image of the brain, demonstrating an intracranial mass lesion (arrow) that was stable in size. Note that it had an altered intensity following the gamma knife treatment. (b, c) Sagittal T1-weighted images demonstrating spinal disseminated lesions (arrowheads) that were stable in size. The resected spinal tumor (arrow) did not recur
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F6
MRI confirmed that the remnant lesions were stable in size [Figure 6].