PMC8247701_01
(a and b) AP and lateral radiographs showing thoracolumbar instrumentation. As well as distal junctional deformity. (c) Expansion of the sacrum; (c) localized sacrum shows narrowing and remodeling of the walls of sacrum.
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F1
T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
(a) T1-weighted sagittal MRI showing an isointense expansile mass in the sacrum; (b and c) T2-weighted sagittal and axial MRI shows a hyperintense mass with small isointense patches. Screws in L1 and T11 vertebral bodies are seen (white narrow arrows).
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F2
T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
Sacral reconstructed C.T. (a) Sagittal images showing expansion of the sacrum, (b) coronal images note enlargement of the sacral foramina.
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F3
T1-weighted and inhomogeneous on T2-weigthed images [Figures 1 and 2]. The CT further confirmed expansion of the sacral canal with enlargement of the foramina (i.e. best seen on sagittal and coronal reconstructed CT images) [Figure 3].
Intraoperative photographs: (a) note protrusion of the tumor from the enlarged sacral foramina (white arrow heads).
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F4
The patient underwent a sacral laminectomy for gross total tumor removal [Figure 4].
(a) H-E 200 staining shows the cells arranged around vascular core containing blood vessels or pseudorosettes (black arrows), typical for MPE. (b) H-E higher magnification shows cells with anaplasia (black arrow heads), (c) note the tumor cells are diffusely reactive with glial fibrillary acidic protein, and (d) diffusely positive for S100 staining.
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F5
Histology and immunohistochemical studies were confirmatory for an anaplastic MPE; the latter findings included; glial fibrillary acidic protein and S100 staining findings consistent with MPE [Figure 5].
At 1-year follow-up, (a) T1-weighted sagittal MRI, small tumor recurrence in the sacrum.
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F6
One year later, the patient had a follow-up sacral MRI scan that documented small residual/recurrent focal tumor [Figures 6 and 7]. She continued to exhibit residual incomplete saddle sensory deficit with urinary dysfunction requiring intermittent catheterization; otherwise she had no other new focal neurological deficits [Figure 6].
(a and b) Total spinal AP and lateral radiographs show persistent distal junctional disease (add-on) with no change in its degree. (c) Photograph of the patient with no apparent deformity.
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F7
One year later, the patient had a follow-up sacral MRI scan that documented small residual/recurrent focal tumor [Figures 6 and 7].