PMC8712332_01
Magnetic resonance imaging. Preoperative imaging revealed isointense lesions on T1-weighted (A) and T2-weighted imaging (B), compressing the spinal cord. Axial enhanced T1-weighted imaging (C) revealed enhanced lesion located at midline premedullary cistern and lateral medullary cisterns (arrows), compressing the brainstem (asterisk). Sagittal enhanced T1-weighted imaging (D, E) showed multiple nodular lesions continuously creeping through the tentorium and meninges of sellar region, skull base, and C1-C6. Postoperative-enhanced MRI (F) proved the spinal and lower region of clivus of the tumor was totally removed.
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F1
HIV testing was negative. Head and neck MRI showed creeping-growth isointense lesions on T1- and T2-weighted images, compressing the spinal cord (Figures 1A,B). After administration of gadolinium, diffuse creeping-growth nodular meningeal masses with skull base, tentorium, sella area, and C1-6 vertebral plane involvement were detected, compressing medulla and adjacent spinal cord (Figures 1C-E). Postoperative MRI confirmed the total resection of the cervical and lower clivus part of the lesion (Figure 1F).
Timeline of the case presentation.
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F2
The patient is free from progression clinically 3 months postoperatively (Figure 2).
Pathological findings. Hematoxylin and eosin (magnification, x100) (A) showing lymphoplasmacytes infiltrated the tumor stroma, overshadowing the meningioma component. Immunohistochemistry testing showed epithelial membrane antigen positive (arrowheads) (magnification, x400) (B), CD20 positive (arrowheads) (magnification, x400) (C), and CD138 positive (arrowheads) (magnification, x400) (D). In conclusion, pathological findings indicate a lymphoplasmacyte-rich meningioma.
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F3
The tumor cells were positive for EMA, P63, PR, and negative for GFAP, Oligo2, and CK; lymphocytes were positive for LCA, CD3, and CD20; plasmocytes were positive for CD138, partly positive for IgG and IgG4, which is consistent with an LRM (Figure 3).