PMC8720450_01
Magnetic resonance imaging T1 sequences with gadolinium contrast- parasagittal views. (a) Brain - Suprasellar enhancement, leptomeningeal enhancement seen along the ventral brainstem and pineal region. (b) Cervical spine- Diffuse leptomeningeal enhancement seen in the ventral/dorsal spinal cord. (c) Thoracic spine - Dorsally compressive thickened lesions at T1 (single asterick) and T6 (double asterick). (d) Lumbar spine - Diffuse enhancement of the conus medullaris and the cauda equina.
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F1
Magnetic resonance imaging thoracic spine T1 sequence with gadolinium contrast, axial (left) and sagittal (right) images at the T6 level. There is an enhancing lesion that appears to be intradural and intramedullary.
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F2
MRI of the spine demonstrated florid enhancement of the leptomeninges from the cervicomedullary junction to the cauda equina. Most pertinent was focal thickening of the leptomeninges at T1 and T6 with mass effect on the spinal cord [Figure 2].
Histopathological stains of T6 lesion. (a) Tumor cells with hypercellularity, atypical mitotic nuclei and astrocytic features. There are foci of microvascular proliferation. Hematoxylin and eosin x200 (b) Positive stain for Glial Fibrillary acidic protein x50. (c) Positive for ATRX gene x100. (d) Tumor cell negative for mutant IDH1 x100.
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F3
In addition, there were foci of microvascular proliferation [Figure 3a]. ATRX [Figure 3c] and negative for CAM 5.2, epithelial membrane antigen and IDH 1 [Figure 3d]. A p53 mutation was also seen.