PMC8942193_01
Magnetic resonance imaging of the trigeminal nerve and spinal intramedullary malignant peripheral nerve sheath tumors. Axial T1 with gadolinium cranial imaging demonstrating the left trigeminal nerve mass (a). Sagittal (b) and axial (c) T1 with gadolinium spinal imaging demonstrating the intramedullary mass. Sagittal T2-weighted imaging showing the same intramedullary mass with surrounding cord edema extending caudally and rostrally (d).
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F1
This led to the finding of a large left trigeminal MPNST [Figure 1a]. MRI of the cervical spine revealed a contrast-enhancing intramedullary mass extending from C7 to T1 levels, with broader edematous changes in the spinal cord between C3 and T4 [Figures 1b-d].
Histopathological imaging of the spinal intramedullary mass. H and E stained slides demonstrate a spindle cell neoplasm with interlacing cellular bundles (herringbone pattern) without obvious cellular borders and moderate pleomorphism (a). There is patchy staining with S100 protein (b). SOX10 (nuclear) stain is primarily lost (only sparse labeling) (c). INI1 is primarily retained, but there was focal lost throughout (d). The Ki-67 proliferation index is elevated (e). There are scattered fragments of CNS (spinal cord) parenchyma seen throughout (arrows), highlighted with GFAP (f). Scale bars (A: 200 mum) (b-f: 100 mum).
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F2
On pathological assessment, the biopsy consisted of a spindle cell neoplasm, forming interlacing cellular bundles of spindle cells (herringbone pattern) without distinct cellular borders [hematoxylin and eosin; Figure 2].