PMC7344188_01
Cervical MRI images from the patient. (A) On axial MRI, at the C5-C6 level, the lesion (the red arrow) partially surrounded the left vertebral artery and extended through the left intervertebral foramen into the spinal canal, with T2 mixed intensity. (B) On axial MRI, at the C5-C6 level, the lesion (the red arrow) exhibited gadolinium enhancement around and T1 hypointensity in the center. (C) On coronal MRI, the lesion spread from C4 to C7 in the spinal canal, especially demonstrating mass effect (the red arrow) at the C5-C6 level. The lesion showed uneven gadolinium enhancement with T1 hypointensity in the center.
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F1
At the C5-C6 level, the lesion partially surrounded the left vertebral artery and extended through the left intervertebral foramen into the spinal canal (Figures 1A,B). On coronal MRI, the lesion spread from C4 to C7 in the spinal canal, especially demonstrating mass effect at the C5-C6 level (Figure 1C).
The photograph and histological staining of the intraspinal biopsy. (A) During the biopsy, an intrathecal gray-white mass on the left ventral side of the C5-C6 spinal cord surrounding the left C5-C6 nerve roots was observed. The mass had a brittle texture and rich blood supply, and the base of the mass was on the dura mater. Histological staining shows a colony of Gram-positive (x400) (B), acid-fast staining negative (x400) (C), periodic acid-Schiff staining positive (x400) (D), and Grocott's methenamine silver staining positive (x400) (E) filamentous branching bacteria, with hematoxylin and eosin staining revealing the Splendore-Hoeppli phenomenon (x200, the white arrow on F). A chronic inflammatory process around the bacteria colony was also observed (x200, F).
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F2
The mass had a brittle texture and rich blood supply, and the base of the mass was on the dura mater (Figure 2A). Histopathological examination of the resected mass showed a colony of Gram-positive, acid-fast staining negative, periodic acid-Schiff staining positive and Grocott's methenamine silver staining positive filamentous branching bacteria, with hematoxylin and eosin (HE) staining revealing the Splendore-Hoeppli phenomenon (Figures 2B-F).