PMC4123255_01
A 47-year-old man with a 2-year history of back pain developed progressive paraparesis 1 week prior to admission. His weakness rapidly progressed to paraplegia. MRI showed an enhancing intramedullary tumor at T8-9 with extensive edema (a). As part of his workup, the patient also underwent MRI of the brain (flair b and enhanced c), which showed no intracranial pathology. Two days later, the patient underwent a T8, T9, and T10 laminectomy and intramedullary tumor resection. Histopathology showed a high degree of nuclear atypia, mitotic activity, and vascular proliferation with thrombosis in regions of necrosis. The pathology was consistent with a glioblastoma (d). Postoperatively, the patient received 30 cycles of radiation therapy. Seven months later, an MRI with enhancement revealed tumor recurrence (e), extending to and including T7-T10. On 11 October 2002, based on the MRI imaging, the patient underwent T6-T11 laminectomy and transdural cordectomy. The illustration shows the excised cord within the dura (f). Histopathology on the resected cord again showed glioblastoma with marked atypia, mitosis, vascular proliferation, and necrosis. In August 2008, he presented with dizziness and diplopia of several months duration. MRI of the brain identified an enhancing mass in the left frontal periventricular white matter (g). Biopsy of this mass showed hypercellular brain parenchyma infiltrated by a population of atypical cells. There was a subependymal accumulation of these cells with mitotic activity (h). A diagnosis of grade III astrocytoma was made. Follow-up thoracic MRI (i) showed a stable exam with postsurgical and postradiation changes from T7 through T11 without gross evidence of progression of disease. Brain MRI in May 2013 (j) showed postradiation effects with ventriculomegaly, but no evidence of tumor recurrence in the frontal lobe. Latest MRI of the brain, taken in November 2013, showed tumor recurrence in the left occipital lobe with extension into the splenium of the corpus callosum, but no evidence of tumor in the frontal lobe (k)
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Magnetic resonance imaging (MRI) with enhancement revealed an enhancing mass of the spinal cord at T8-9, with edema extending to the mid T6 region rostrally and to T12 caudally [Figure 1a]. As part of his workup, the patient also underwent MRI of the brain [Figure 1b, c], showing no intracranial pathology. On the basis of this histopathology, a diagnosis of GBM was made [Figure 1d]. An MRI taken 7 months after surgery revealed tumor recurrence [Figure 1e]. T6, T7, and T11 laminectomy and transdural cordectomy [Figure 1f]. The proximal and distal dural stumps were oversewn in a watertight fashion. MRI of the brain identified a left frontal mass [Figure 1g]. September 2008, he underwent a stealth-guided biopsy of the left frontal mass, which revealed grade III astrocytoma [Figure 1h]. Subsequently, he received 59.4 Gy in 33 fractions of radiation and was restarted on monthly cycles of temozolomide. MRIs continue to show stable postoperative change and enhancement [Figure 1i]. Most recently, brain MR taken on 14 May 2013 showed interval resolution of the left frontal mass [Figure 1j]. MRI taken on 12 November 2013 [Figure 1k] showed a left occipital mass with extension into the corpus callosum.