PMC9062964_01
(a and b) Sagittal and axial T1-weighted MRI with contrast of the thoracic spine. (c and d) Sagittal and axial T2-weighted MRI of the thoracic spine. (e and f) Axial and coronal brain MRI with contrast. (a-d) The images demonstrate a T3-T7 intramedullary lesion with heterogenous peripheral enhancement (Arrow). The lesion measures 10.6 x 1.3 cm in craniocaudal and anterior-posterior diameters, respectively. (e and f) The brain MRI shows no evidence of intracranial space-occupying lesions.
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F1
Thoracolumbar MRI with contrast revealed an intramedullary high T2-signal lesion at T3-T7 level [Figures 1a-d]. Brain MRI was unremarkable [Figures 1e and f].
Microscopic images of spinal cord glioblastoma. (a) Low- power micrograph showing high cellularity with palisading necrosis in the middle. (b) Intermediate-power micrograph showing both mitotic figures in green circles and microvascular proliferation (green arrows). (c) Glial differentiation is confirmed by positive nuclear staining for the antibody Olig2 (clone 211F1.1).
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F2
The histopathological sections showed a hypercellular malignant glioma [Figure 2].
(a) Axial fluid-attenuated inversion recovery (FLAIR) MRI of the brain. (b and c) Coronal T1-weighted MRI with contrast of the brain. (a-c) There are two enhancing subependymal lesions noted in the right peritrigonal region, associated with a high signal in the FLAIR MRI (Arrow). Furthermore, there is a lesion in the inner aspect of the genu and isthmus of the corpus callosum (Arrow).
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F3
A repeat brain MRI demonstrated cerebral dissemination of the spinal tumor [Figure 3].
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(a-c) Sagittal T1-weighted MRI with contrast and T2-weighted MRI of the spine. (d) Axial T1-weighted MRI with contrast at the level of the cystic component. (e and f) Axial and coronal T1-weighted brain MRI with contrast. (a-d) The images demonstrate a large intramedullary heterogenous lesion extending from the level of C3-C4 until T8-T9. The lesion is causing expansion of the spinal cord, associated with a small cystic and necrotic component mainly at C7 down to T6 (Arrow) with heterogenous enhancement. Furthermore, there are areas of heterogenous enhancement of the exiting nerve roots. (e and f) The images demonstrate no intracranial space-occupying lesions or abnormal parenchymal/meningeal enhancement.
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Microscopic images of spinal cord glioblastoma. (a) Hematoxylin and Eosin-stained section shows low-to- moderately cellular infiltrative glioma. There is a focus of endothelial proliferation with no evidence of necrosis. The tumor cells appear round/oval and some are elongated and hyperchromatic. A few mitotic figures are observed. There are no Rosenthal fibers. (b) The tumor cells are immunopositive for GFAP and p53 (Not shown). (c) Ki-67 immunolabeling is estimated to be high (30-40%). (d) Neurofilament immunostain highlights a significant degree of infiltration
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F5
The histomorphology was typical of glioblastoma [Figure 5] with microvascular proliferation, and a very high proliferation index (30-40%) by Ki-67 immunostaining.