PMC9479570_01
Gadolinium-enhanced T1-weighted axial (a) and sagittal (b) MRI showing a midline lesion in the posterior fossa with peripheral contrast enhancement in January 2011. Gadolinium-enhanced sagittal T1-weighted MRI showing multiple intradural extramedullary spinal lesions at C1, Th5 (c), and C5 (d), with leptomeningeal enhancement (e) in July 2019.
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F1
Neuraxial magnetic resonance imaging (MRI) showed multiple contrast-enhancing brain and spinal cord lesions, with leptomeningeal enhancement [Figure 1].
Photomicrograph (H&E, x40) showing a diffuse and monomorphic pattern of clear cell proliferation amidst a rich vascular network; the black arrow indicates a vessel with an increased caliber in relation to most vessels, which have a capillary caliber (a). Photomicrograph (H&E, x400) showing detail of clear cell proliferation without atypia (black arrows) amid numerous capillary blood vessels (white arrow) and major vessels (black arrowhead) (b).
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HB [Figure 2]. He was discharged without new neurological deficits.
Images demonstrating the aggressive progression of the lesions. Gadolinium-enhanced T1-weighted sagittal cervical spine MRI showing a ventral intradural extramedullary lesion at C1 in October 2019 (a); MRI performed in December 2019 demonstrated rapid progression of the lesion and spinal cord compression (b). MRI showing a right cerebellopontine angle tumor in December 2019 (c); expansion of the lesion was observed in April 2020, causing brainstem compression and fourth ventricle displacement (d). MRI showing a small right temporo-occipital tumor and a left tentorial tumor in January 2020 (e); growth of both lesions was observed in July 2020 (f).
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F3
Serial control examinations during outpatient follow-up showed progression of previously existing lesions and the appearance of new lesions in the neuroaxis [Figure 3].