PMC9275449_01
Plain and contrast enhance magnetic resonance imaging (MRI). (A) Sagittal T1-weighted MRI showed isointensive signal lesion in spinal cord at T9-10 level. (B) Sagittal T2-weighted MRI demonstrated a hyperintense signal mass. (C) Sagittal postcontrast T1-weighted MRI showed the mass was homogeneously enhanced. (D) Axial postcontrast T1-weighted MRI showed the lesion was locally connected to the nerve root. The Red arrow is mainly used to show the location of the lesion.
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F1
Moreover, the lower segment of the cauda equina was thickened and expanded (Figure 1).
Intra-operative image of the lesion located at the right ventral margin. (A) The lesion had abundant blood supply (the arrow); (B) The gross total resection was achieved. The Red arrow is mainly used to show the location of the lesion.
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F2
Therefore, the spinal cord and tumor boundary were unclear (Figure 2A). Careful separation, protection of the spinal cord, and complete microscopic resection of the tumor were performed (Figure 2B).
(A,B) The histology of the intramedullary lesion showed chronic inflammatory lymphoplasmacytic infiltrate with fibrosis, 10 x 10 magnified view showed inflammatory cell collections (Hematoxylin-eosin, magnification 100x). (C,D) 20 x 10 magnified view demonstrated chronic inflammatory infiltration (hematoxylin-eosin, magnification 200x). (E,F) 40 x 10 magnified view showed rich lymphoplasmacytic infiltrates (plasma cells, eosinophils, macrophages, and lymphocytes) with storiform arrangement of spindle cells and dense fibrosis. (G) Immunohistochemistry with plasma cells (CD38+) in the infiltration area. (H) Immunohistochemistry with plasma cells (CD138+) in the infiltration area. (I) The IgG4+ cells account for more than 50% of the plasma cells.
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F3
Our differential diagnoses included lymphoma, meningioma, neurilemmoma, and small cell malignancies (Figures 3A-F). The positive immunoglobulin G4 staining of plasma cells showed gross cellularity of >50/high-power field (Figure 3I) and positive CD138 staining (Figure 3H). The histiocytes showed positive CD68 staining (Figure 3G).