PMC10150021_01
(A) T1W + contrast MRI sagittal view in a well-defined intradural extramedullary lesion, opposite to the T6/T7 level. (B) Hypointense lesion on coronal MRI T1W and enhancing lesion on T1W + contrast, with extension into the right intervertebral foramina, causing spinal cord compression, which exerts a mass effect upon the spinal cord, displacing it to the left.
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F1
The spine MRI on sagittal view exhibited a right-sided T6-T7 well-defined intradural extramedullary lesion, which was hyperdense on T2W (Figure 1A). On coronal view, right intervertebral foramina extension causing spinal cord compression and left cord displacement was found (Figure 1B). Immunohistochemical stains with an appropriate control are performed, showing diffuse reactivity for epithelial membrane antigen (EMA) (Supplementary Figure S1A) and progesterone receptor (Supplementary Figure S1B). The proliferative index using Ki-67 is low and estimated at 2%-3% (Supplementary Figure S1C).
Axial MRI shows avid enhancement attachment with dural attachment, measuring 1.4 cm x 1.5 cm x 3 cm in maximum AP, TS, and CC dimensions, respectively. The spinal cord is displaced to the left.
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F2
Axial spine MRI displayed avid enhancement with a dural attachment measuring 1.4 cm x 1.5 cm x 3 cm in maximum anterior-posterior (AP), transection (TS), and craniocaudal (CC) dimensions, respectively (Figure 2).
(A) An extradural component appearing before the dura opening. (B) Debulking after the intradural component. (C) After debulking.
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F3
The extradural lesion and the foraminal part were identified and resected (Figure 3C).
Histomorphology of psammomatous meningioma. (A,B) H&E stain showing meningothelial neoplasm with prominent psammomatous calcifications (A: 20x, B: 40x). (C,D) H&E stain reveals meningothelial cells featuring whorls, frequent intranuclear pseudo-inclusions (blue arrows), and some nuclear holes (40x). H&E, hematoxylin and eosin stain.
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F4
The intervening meningothelial cells display frequent intranuclear pseudo-inclusions and some nuclear holes (Figures 4B,C).