PMC9990802_01
Magnetic resonance imaging T1 and T2 sequences at (a) preoperative, demonstrating cord expansion suspicious for the presence of a tumor; (b) postoperative, demonstrating gross total resection and subtle enhancement along the posterior aspect of the cord, and (c) 6-month post-operative, demonstrating new leptomeningeal enhancement concerning for metastatic spread of disease. (d) 8-month postoperative (T1 with contrast) demonstrating intracranial metastasis (circled in red) in the cerebellum and brainstem. (e) 8-month postoperative (T1) demonstrating hydrocephalus in the temporal horns of the lateral ventricles and the fourth ventricle.
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F1
Magnetic resonance imaging (MRI) of the cervical spine revealed a 4.1 x 1.2 x 1.5 cm mixed cystic and solid intramedullary mass spanning C3-C6 with cord edema extending superiorly and inferiorly to these levels [Figure 1a]. MRI at 1 month revealed subtle enhancement around the surgical resection site that may indicate postsurgical scar tissue [Figure 1b]. New MRI demonstrated disease progression with leptomeningeal enhancement in the thoracic and lumbar spine [Figure 1c], intracranial metastasis [Figure 1d], and hydrocephalus [Figure 1e].
Histologic sections show a fibrillary background with atypical mature appearing neurons, including binucleate forms (a). Other sections have a higher grade component with marked atypia and atypical mitoses (b). Glial fibrillary acidic protein is positive in the majority of neoplastic cells (c), and Synaptophysin highlights an atypical neuronal component (d).
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F2
Histologic analysis showed a pleomorphic neoplasm with atypical glial and dysmorphic neuronal cells, some of which displayed binucleation [Figure 2a]. In addition, there was an area of hypercellularity with increased atypia [Figure 2b], consistent with anaplastic transformation, and presence of mitoses (focally up to 8 mitotic figures per ten high-power fields). Glial fibrillary acidic protein (GFAP) highlighted neoplastic glial cells [Figure 2c] and synaptophysin highlighted neoplastic neurons [Figure 2d].