PMC4352905_01
Cervical MRI: (a) midsagittal T2 MRI (TR = 4000, TE = 98) and (b) midsagittal T1 postcontrast (TR = 659, TE = 8.7) imaging of the cervical spine showing a C2-C7 ill-defined extradural mass that is hypointense on T2 and enhances with contrast most predominant at C6-C7. ((c) and (d)) Two axial slices of a preoperative T1 postgadolinium contrast (TR = 591, TE = 7.3) MRI of the cervical spine passing through the C6-C7 level demonstrates an extradural, enhancing mass invading the spinal canal eccentric to the left.
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A repeat MRI performed at our institution showed an ill-defined predominantly extradural enhancement along the left aspect of the cervical spinal canal, most apparent at C6-C7, but also extending between C2 and C7 (Figure 1).
Histopathological investigation of the biopsied mass included (a) H&E staining that revealed round hyperchromatic nuclei with little cytoplasm and numerous mitoses. (b) Positive PAS staining of the tumor cells shows these cells to be glycogen rich. There is also positive staining for (c) CD-99 and (d) FLI-1.
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Our pathologists noted round, hyperchromatic nuclei with little cytoplasm and multiple mitosis suggestive of a primitive neuroectodermal tumor in surrounding necrotic tissue (Figure 2(a)). Further histochemical staining showed that the tumor cells stained positively for PAS, CD-99 and FLI-1 (Figures 2(c) and 2(d)).