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Magnetic resonance imaging of a mass lesion between the parapharyngeal space and cerebellomedullary angle across the jugular foramen. The lesion was isointense to hyperintense on diffusion-weighted images (A, E), isointense to hyperintense on T2-weighted images (B, F), isointense to hypointense on T1-weighted images (C, G), and homogeneously enhanced with gadolinium (D, H).
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In August 2009, gadolinium-enhanced brain magnetic resonance (MR) imaging demonstrated a mass lesion between the parapharyngeal space and cerebellomedullary angle along the ninth and tenth cranial nerves across the left jugular foramen (Fig. 1).
(A-C) Gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging. The image was obtained 3 months after the initial MR imaging (Fig. 1) and shows a considerable tumor enlargement both in the intracranial and parapharyngeal spaces.
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MR imaging revealed considerable tumor enlargement both in the intracranial and parapharyngeal space (Fig. 2).
Intraoperative view: an extra-arachnoid tumor involving the ninth and tenth cranial nerves. (A) Arachnoid membrane over the tumor (arrow). (B) No clear plane was observed between the tumor and nerves (arrow), suggesting an infiltrating lesion.
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Following the diagnosis of a primary lower cranial nerve malignant tumor, the lesion was explored by performing a left lateral suboccipital craniotomy in November 2009 (Fig. 3).
(A) Hematoxylin-eosin staining and (B) immunohistochemical staining for CD20, (C) CD79, and (D) MUM1. Magnification x400.
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Immunohistochemical staining demonstrated that the tumor was positive for cluster of differentiation 20 (CD20), CD79a, B-cell lymphoma 6, and multiple myeloma oncogene 1 but negative for CD30, CD10, CD3, and CD5 (Fig. 4).