PMC4672249_01
Pre-operative magnetic resonance images. Sagittal plane (A) and transverse plane (B) T2-weighted images showing a hyperintense, intramedullary mass at the level of the L3-4 intervertebral disk space (asterisk) and associated peritumoral edema cranial to the mass (arrow). Sagittal plane (C) and transverse plane (D) post-contrast T1-weighted images showing marked, homogenous contrast enhancement of the mass.
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F1
Magnetic resonance imaging (MRI; 1.5-T MAGNETOM Espree; Siemens) of the thoracolumbar spine revealed a slightly right-sided, discrete, intramedullary mass at the level of the L3-4 intervertebral disk space; the mass occupied over 90% of the vertebral canal (Figure 1).
Histological and immunohistochemical sections of spinal hemangioblastoma. (A) Predominately spindle cells separated by numerous ectatic capillaries (arrow). Hematoxylin and eosin, 10x. (B) Higher magnification view of spindle cells (arrow) separated by moderate fibrillary stroma. Hematoxylin and eosin, 40x. (C) Spindle cell population and stroma within the neoplasm is diffusely positive for neuron-specific enolase. Capillaries within the section are negative (arrow; negative internal control), 20x. (D) Capillaries within the neoplasm are diffusely positive for factor-VIII, 20x.
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F2
On histopathological evaluation, the spinal mass was composed of mildly pleomorphic spindle cells arranged in loose streams and bundles separated by variable amounts of fibrillar stroma (Figure 2).
Post-operative magnetic resonance images acquired 9 months after surgery. (A) Sagittal plane T2-weighted image showing no residual peritumoral edema (asterisks are at the level of the L3-4 intervertebral disk space). (B) Transverse plane T2-weighted image at the level of the L3-4 intervertebral disk space, showing atrophy of the spinal cord (arrowhead). Sagittal plane (C) and transverse plane (D) post-contrast T1-weighted with Fat Sat images at the level of the L3-4 intervertebral disk space. (E) Transverse plane pre-contrast T1-weighted image at the level of the L3-4 intervertebral disk space. Atrophied spinal cord is visible in the left side of the vertebral canal on all transverse images (arrowhead). The right side of the vertebral canal is occupied by material that is hypointense to spinal cord on pre-contrast and post-contrast T1-weighted transverse images and mixed intensity on T2-weighted transverse image (arrow). This material may represent CSF and adhesions at the site of surgery.
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F3
T1W with Fat Sat images was visible to the right of the atrophied spinal cord and corresponded to an area of mixed intensity on the T2W images. This material may represent CSF and adhesions within the vertebral canal secondary to atrophy of the spinal cord and surgery (Figure 3). The application of a chemical Fat Sat to the post-contrast T1W image (but not to the pre-contrast T1W image) made distinction of this tissue from the spinal cord more apparent.