PMC6826275_01
(a) Sagittal T1-weighted postgadolinium magnetic resonance (MR) images through the cervical spine showing intense contrast enhancement of an intramedullary lesion from the C1 to C2 level. (b) Sagittal T2-weighted MR images demonstrating the heterogeneous intramedullary lesion extending from the medulla oblongata to the C4 level, which was thought to represent spinal cord edema surrounding the enhanced mass. (c and d) Scans after steroid pulse therapy. (c) Sagittal T1-weighted postgadolinium MR images showing no change in the enhanced lesion. (d) Sagittal T2- weighted MR images showing a decrease in cord edema.
SNI-10-201-g001.jpg
PMC6826275_01_SNI-10-201-g001.jpg
F1
The cervical MR revealed a heterogeneously enhancing, expansile intramedullary cord lesion at the C1-C2 level, accompanied by marked edema extending from the medulla oblongata to the C4 level [Figure 1]. The more likely diagnosis of a tumor was later confirmed when the follow-up magnetic resonance imaging (MRI) showed reduced edema around the unchanged contrast-enhancing C1-C2 intramedullary mass [Figure 1].
(a) Photomicrographs of the operative specimen at low power (original, x100) displaying a mixed population of large atypical cells and small lymphocytes (two-cell pattern). Large atypical cells had proliferated with a solid to sheet-like pattern. The small lymphocytes had invaded the stroma. There were no syncytiotrophoblastic giant cells. (b) High-power micrograph of the tumor (original, x400) displaying large round cells characterized by nuclear atypia with hyperchromatic large ovale and a clear cytoplasm. Invading lymphocytes were matured. (c-f) Immunohistochemical stains of the tumor. The large atypical cells were diffusely positive for placental alkaline phosphatase and C-kit (original, x100). (c) Placental alkaline phosphatase. (d) C-kit. (e) alpha-fetoprotein. (f) Human chorionic gonadotropin.
SNI-10-201-g002.jpg
PMC6826275_01_SNI-10-201-g002.jpg
F2
The tumor consisted of a mixed population of large cells (e.g., large round nuclei, hyperchromasias, with clear cytoplasm) and mature lymphocytes [two-cell pattern, Figure 2]. Immunohistochemical studies positively stained for placental alkaline phosphatase and C-kit [Figure 2].