PMC8769451_01
Preoperative spinal MRI (A-C, sagittal images; D-F, axial images). T1-weighted images (A, D) show an intradural extramedullary oval-shaped isointense lesion at T10 level, which is hyperintense on T2-weighted images (B, E) and has an intense peripheral ring enhancement with homogenous central enhancement by gadolinium (C, F). An extensive intramedullary hyperintense area is also revealed on T2-weighted images (B, E), and the part of the area in the spinal cord is enhanced at T10 level (arrow; F). MRI: magnetic resonance imaging.
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F1
T2-weighted images; and had an intense peripheral ring enhancement with homogenous central enhancement by a contrast medium (Fig. 1). T2-weighted MRI also revealed an intramedullary hyperintense area extending from T4 level to conus medullaris, which was partially enhanced at T10 level. There were no findings suggesting metastatic lesions on whole-body computed tomography scans. The tumor was diagnosed as neurinoma or meningioma tentatively, and removed surgically as follows.
An intraoperative photograph through the surgical microscope (upper) and the illustration (lower). After dural opening, a reddish mass (asterisk) and some dilated veins (arrows) are found on the thoracic spinal cord.
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F2
T9-10 and the dura mater was opened, a reddish mass and dilated veins were revealed on the thoracic spinal cord and under the arachnoid membrane (Fig. 2).
Histopathological findings. Hematoxylin and eosin staining (A) shows many capillary-sized vessels lined by endothelial cells and tumor cells with mitoses (arrows). Immunostaining shows that endothelial cells and tumor cells are positive for CD31 (B) and CD34 (C), and that nuclei of tumor cells are positive for ERG (D) and negative for STAT6 (E). MIB-1 index is approximately 32.6% (F). Scale bar = 25mum. ERG: erythroblast-transformation- specific-related gene.
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F3
On histopathological examinations, tumor cells had oval nuclei with frequent atypia as well as mitoses and pale eosinophilic cytoplasm, forming lobular architectures associated with capillary-sized vessels (Fig. 3A). Immunostaining showed that endothelial cells and tumor cells were positive for factors CD31 (Fig. 3B) and CD34 (Fig. 3C), and that nuclei of cells were positive for erythroblast-transformation-specific-related gene (ERG) (Fig. 3D). However, tumor cells were negative for signal transducer and activator of transcription 6 (STAT6) (Fig. 3E). MIB-1 index was approximately 32.6% (Fig. 3F).