PMC10310954_01
(A) Cranial MRI scan showing diffuse meningeal enhancement. (B) Thoracic and lumbar spinal cord MRI showed extensive thickening and enhancement of the spinal dural of the thoracolumbar and sacral canal, especially around the end of the spinal cord. (C) Electroencephalogram showing moderately abnormal electroencephalogram; background activity was slow, and numerous theta slow waves; frontal and temporal regions showed mixed slow wave firing, especially on the left side. (D) CSF cytology shows an increased number of activated monocytes. (E) PET-CT shows multiple hypermetabolic areas scattered in the spinal canal at the level of the T2-L2 vertebral body, thus indicating the possibility of intramedullary tumors with intraspinal metastasis. (F) Lumbar MRI: 1. Extensive thickening and enhancement of the dura mater of the thoracolumbar and included sacral canals, especially around the end of the spinal cord, which did not change significantly from 1st MRI. 2. Abnormal signals in the spinal cord at about the T12-L1 vertebra level.
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F1
A Cranial magnetic resonance imaging (MRI) scan showed diffuse meningeal enhancement caused by infection (Figure 1A). The results showed extensive thickening and enhancement of the thoracolumbar spinal meninges (Figure 1B). Electroencephalogram showed increased slow waves in frontal and temporal lobes (Figure 1C). However, we noticed that there was no significant increase in the white blood cell count, and the cytology of the patient's cerebrospinal fluid showed an increase in the number of activated monocytes while malignant cells were not detected (Figure 1D). A positron emission tomography-computed tomography (PET-CT) scan was performed, and the results showed multiple hypermetabolic areas scattered in the spinal canal at the level of the T2-L2 vertebral body, thus indicating the possibility of intramedullary tumors with intraspinal metastasis (Figure 1E). On the 27th day, the thoracolumbar MRI scans were re-examined (Figure 1F), showing a significant increase in abnormal intramedullary signals at the thoracic (T) 12-lumbar (L) 1 vertebra level compared to that seen in the first scan.
(A) HE staining (x200) showed diffuse growth of tumor cells, small and consistent tumor cells, visible microvascular proliferation, and occasional mitoses. (B-F) Immunohistochemistry. (B) H3K27M (+) (x200), (C) GFAP (+) (x400), (D) Oligo2 (+) (x400), (E) Ki-67(+) (x200), and (F) IDH-1(-) (x200).
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F2
The histopathological examination of the neuroepithelial tumor removed from the spinal tissue revealed a malignant tumor. The immunohistochemistry results showed GFAP (+), Oligo-2 (+), H3K27M (+), Ki-67 (+), IDH-1 (-), and EMA (-) (Figure 2).