PMC8769434_01
Changes over time in spinal MRI findings in a spinal intramedullary tumor with edema (case 1). (A) T2-weighted imaging (T2WI) prior to admission showed a high-intensity area at the C6-Th1 level. (B) Contrast-enhanced T1-weighted imaging (CET1WI) prior to admission revealed that the tumor was diffusely enhanced at the C6-Th1 level. (C and D) T2WI and CET1WI on admission showed tumor growth. (E and F) MRI at the time of the deterioration of symptoms showed tumor growth with severe edema extending to the brain stem. (G and H) MRI at 14 days after bevacizumab administration showed tumor regression with significant improvement in edema. (I-K) MRI at 14 months after discharge showed tumor regrowth and intracranial dissemination of the tumor (white arrow).
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F1
MRI at the initial visit had shown an intramedullary tumor at the C6-Th1 level (Fig. 1A and 1B), but MRI on admission revealed tumor growth (Fig. 1C and 1D). MRI showed tumor growth with severe edema extending to the brain stem (Fig. 1E and 1F). MRI at 14 days after bevacizumab administration showed tumor regression with significant improvement in edema (Fig. 1G and 1H). Fourteen months after discharge, however, her paralysis gradually became exacerbated, and MRI showed tumor regrowth and intracranial metastases (Fig. 1I-K).
Histological and immunohistochemical findings in case 1. (A and B) Hematoxylin and eosin staining showed a piloid appearance. Numerous corpora amylacea (black arrow) were seen within the tumor (A: x200, B: x400). (C) Immunohistochemistry for H3K27M-mutant protein showed strong nuclear positivity (x400).
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F2
A diagnosis of low-grade astrocytoma was made (Fig. 2A and 2B). The definitive diagnosis was DMG, H3K27M-mutant (Fig. 2C).
PMC8769434_02
Changes over time in spinal MRI findings in a spinal intramedullary tumor with edema (case 2). (A) T2WI prior to admission showed a high-intensity area at the C1-C4 level. (B) CET1WI prior to admission revealed that the tumor was enhanced at the C4 level. (C and D) T2WI and CET1WI on admission showed tumor growth at the C1-C5 level with severe edema extending to the brain stem. (E and F) MRI at 7 days after bevacizumab administration showed tumor regression with significant improvement in edema. (G-I) MRI at 7 months after the transfer out of our hospital showed intracranial dissemination of the tumor (white arrow).
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F3
She was referred to our department for a suspected spinal intramedullary tumor on MRI taken at her previous hospital (Fig. 3A and 3B). MRI on admission revealed a spinal intramedullary tumor at the C1-C5 level (Fig. 3C and 3D). MRI 7 days after bevacizumab administration showed tumor regression with improved edema (Fig. 3E and 3F). She died 11 months after the transfer due to intracranial dissemination of the tumor (Fig. 3G-I).
Histological and immunohistochemical findings in case 2. (A and B) Hematoxylin and eosin staining showed signs of glioblastoma or diffuse midline glioma, including dense proliferation of tumor cells and necrosis (A: x200, B: x400). (C) Immunohistochemistry showed no expression of IDH1 R132H-mutant protein (x400). (D) Mutation analysis using Sanger sequencing showed a H3F3A K27M mutation.
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F4
Histologically, the tumor showed a dense proliferation of tumor cells with a necrotic focus, and a histological diagnosis of high-grade glioma, suggestive of glioblastoma or DMG, was made (Fig. 4A-C). The patient was diagnosed with DMG, H3K27M-mutant (Fig. 4D).