PMC7781032_01
(A) T2 mid-sagittal (B) T1 mid-sagittal (C) STIR mid-sagittal (D) T1+C mid-sagittal, demonstrated an infiltrating intradural extramedullary, isointense on T1 and hyper intense on T2, mildly enhancing spinal cord lesion involving C2-C4 with an extension to extradural space of C3-T2.
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There were no cervical or thoracic vertebral marrow changes (Figures 1 and 2).
(A) T1 axial at C2 (B) T1 axial at C4 (C) T1+C at C4, demonstrated circumferential enhancing lesion in the intradural and extramedullary space with severe spinal stenosis (blue arrow), the lesion exits the spinal canal via neural exit foramina (black arrow), extended to the right semispinalis cervicis, semispinalis capitis, trapezius, lavatory scapulae and the anterior scalene muscles (white arrow).
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There were no cervical or thoracic vertebral marrow changes (Figures 1 and 2).
(A) MRI myelogram (B) CT myelogram coronal (C). CT myelogram mid-sagittal, demonstrated a complete absence of contrast (broken stick appearance of conventional myelography) in the leptomeningeal space from C2 to T1 while uniform ossification of the space below T1.
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MR myelogram confirmed the CT myelogram findings (Figure 3).
Immunohistochemistry demonstrated positivity of CD45, CD20 and Ki 67 which were features of high-grade B cell lymphoma.
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The histopathology was consistent with a high-grade B cell lymphoma. The immunohistochemistry staining showed positivity for CD45, CD20, CD10, Bcl-2, and >99% positivity of Ki 67 (high proliferative index) (Figure 4).