PMC9873374_01
Preoperative thoracic MRI. (A) The sagittal T2WI revealed the homogeneous anterior-posterior spinal cord compression at the T9-T11 level, with a hypointense signal. One to two segments of the head and tail of the lesion presented cavitary changes in the spinal cord. The axial T2WI (corresponding to the white line in A) revealed the ventral and dorsal thickening of the dura, with a hypointense signal. (B) The sagittal T1WI presents the hypointense signal (arrow).
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The bony structures and paravertebral soft tissues were not involved ( Figure 1 ).
(A) The thickened dorsal dura presenting a band-like shape and rubbery texture (approximately 5.0 cm in diameter). (B) View of the surgical site after the complete resection of the thickened dorsal dura.
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The resected thickened dura was processed for biopsy ( Figure 2 ).
(A) A rubbery lesion resembling fish meat. (B) On histopathological examination, the dural mass and surrounding soft tissues presented with chronic and acute inflammation, inflammatory granulomatous micro-abscesses, and a few granulomas. Fibrous tissue hyperplasia, calcification, and a large number of plasma cells were present. The immunohistochemistry revealed the large-scale infiltration of IgG4-positive plasma cells.
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The immunohistochemistry suggested an IgG4-related autoimmune disease, which led to the final diagnosis of IgG4-RSP ( Figure 3 ).
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Preoperative cervical MRI. (A) The sagittal T2WI revealed a slightly hyperintense signal (arrow). (B) The sagittal T1WI revealed a hypointense signal (arrow).
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The serological tests revealed a serum IgG level of 9.76 g/L, which was within the normal range (8.00-16.00 g/L). The MRI manifestations included a strip-shaped mass in the dorsal dura at the C4-T2 level, a slightly hyperintense signal on T2WI, and a hypointense signal on T1WI ( Figure 4 ).
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