PMC5005550_01
Radiographic findings. (a) Preoperative MRI indicates a heterogeneously enhancing epidural mass (arrows) at T10-12 extending from the spinal canal into the right T11-12 foramen. CT shows that the osseous elements are intact. (b) Postoperative imaging shows T10-12 laminectomies and gross total resection of the lesion. PET imaging 1 and 7 months after resection shows no abnormal FDG uptake. Sag: sagittal, ax: axial, and gad: gadolinium.
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T10-T12, causing severe cord compression (Figure 1(a)). The mass was extended through the right neural foramina at T11-12 and T12-L1. CT did not suggest osseous involvement (Figure 1(a)). The patient underwent a T10-12 laminectomy for gross total resection of the tumor (Figure 1(b)), with preservation of motor and sensory function, resolution of urinary hesitancy, and significant improvement in the back pain. Postoperative MRI and PET scan did not reveal residual or metastatic tumor (Figure 1(b)).
Histologic findings. (a) H&E stain within the tumor shows the small round blue cell appearance. (b) Ki67 immunostaining indicates a very high mitotic index (60-70%). (c) H&E stain demonstrates tumor invasion through the perineurium and into the right T11 nerve root. (d) Tumor invasion in the T11 nerve root is demonstrated by tumor cells interspersed within S100-positive Schwann cells. The tumor itself was S100-negative. H&E: hematoxylin & eosin.
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Pathologic examination indicated a small round blue cell neoplasm (Figure 2(a)) composed of primitive densely packed cells with a very high mitotic index (60-70% of cells positive for Ki67) (Figure 2(b)). Microscopic analysis of the resected right T11 nerve root showed tumor invasion through the perineurium (Figures 2(c) and 2(d)).