PMC8202386_01
Magnetic resonance imaging spine axial plane: A homogeneously enhancing intradural extramedullary mass lesion was seen at C4/5 level with extension in to the right C4 neural foramina causing widening of the foramen. The spinal cord was severely compressed and displaced to the left side
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F1
The lesion caused severe cord compression on the right side and distortion of the anatomy of the spinal cord [Figure 1].
(a and b) Intraoperative appearance of the tumor. Mark 1: Cut edge of the cervical dura. Mark 2: Dark bluish-colored tumor which is reflected laterally away from the spinal cord which lies under the cut edge of dura mater
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F2
Intraoperatively, bluish colored dumbbell-shaped extremely vascular tumor was identified along with underlying hematoma caused by a rent in the right-sided vertebral artery [Figure 2].
Microscopic appearance of the tumor: (a) (H and E x10) Heavily pigmented tumor composed of sheets of polygonal cells. (b) (H and E x40) Large vesicular nuclei and prominent nucleoli can be appreciated as places
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F3
On histology, the tumor was composed of sheets and nodules of heavily pigmented polygonal cells [Figure 3].
(a) (H and E x10) and (b) (H and E x40) Postbleach sections showing large polygonal and epithelioid tumor cells with abundant eosinophilic cytoplasm and large vesicular nuclei with prominent nucleoli
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F4
There was no significant mitotic activity or necrosis [Figure 4].
Immunohistochemistry: (a) (HMB45 x10) Tumor cells showing diffuse strong positivity for HMB45. (b) (S100 x10) Tumor cells showing diffuse positivity for S100. (c) (Mib1 x10X)- Ki 67 was very low, around 1% in tumor cells
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F5
Ki 67 index was around 1% [Figure 5].