PMC9998981_01
Pre-operative sagittal T1-weighted (A), sagittal (B) and axial (F) post-gadolinium T1-weighted, sagittal (C), coronal (D), axial (E) T2-weighted Nuclear Magnetic Resonance (MRI) images demonstrating the presence of two right sided extradural spinal lesions (arrows) at C5-C7 levels one of which is larger with intraforaminal and paravertebral extension and "dumbbell" shape. Postoperative axial post-gadolinium T1-weighted and fat suppression (G), Gradient echo (GRE) (H), and T2-weighted (I) MRI images demonstrating gross total resection (GTR) of lesions and placement of fat tissue (asterisk) to reinforce dural closure.
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Spinal cord Magnetic Resonance Imaging (MRI) demonstrated two right intracanal extradural and intra/extra-foraminal lesions at the cervical level: the first lesion measured 20x10mm and was located at the C6-C7 level with paravertebral extension and "dumbbell" shape; the other smaller one was located at C5-C6 level ( Figure 2 ). The patient underwent a postoperative cervical MRI, which confirmed radical excision of both lesions ( Figure 2 ).
(A) Malignant melanotic nerve sheath tumor (MMNST) composed by pleomorphic cells, with spindle to polygonal shape, organized on fascicles (star) or sheets of roughly syncytial epithelioid cells (arrowhead), and numerous elements with heavy pigment deposits (H&E, magnification 20x). (B) Cellular details show the presence of occasional mitoses (arrows) and brown finely granular melanin pigment (H&E, magnification 40x).
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Neoplastic cells featured nuclear polymorphisms and evident nucleoli as well ( Figure 3 ).