PMC8769380_01
Preoperative MRI scan. Gd-enhanced spinal MRI revealing that tumors with syrinx are located at the C7 and Th8. Sagittal image of the (A) cervicothoracic and (B) lumbar region. (C) An axial image of Th8. (D-F) Gd-enhanced brain MRI demonstrating tumors in the cerebellar hemisphere and close to the medulla oblongata. Gd: gadolinium, MRI: magnetic resonance imaging.
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F1
MRI revealed that the spinal cord tumor at Th8 had grown (Figs. 1A-1C). Furthermore, the MRI indicated several cerebellar hemangioblastomas, which were asymptomatic (Figs. 1E-1F).
(A) Postoperative Gd-enhanced MRI of the spinal cord showing a small residual tumor in the Th8 region. (B) A sagittal and (C) an axial image confirming the presence of the residual tumor 18 months post-surgery. (D-E) Gd-enhanced brain MRI showing a newly appeared tumor in the cerebellar hemisphere (indicated by an arrow) and its ventricular enlargement (F). Gd: gadolinium, MRI: magnetic resonance imaging.
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F2
The tumor was removed sub-totally because of the decreased amplitude of the transcranial motor evoked potential during surgery (Fig. 2A). MRI demonstrated a regrowth of the residual spinal tumor (Figs. 2B and 2C). Additionally, the lateral ventricles were enlarged (Figs. 2D-2F).
Gd-enhanced MRI of the spinal cord demonstrating a small residual tumor in the Th8 region. (A) A sagittal and (B) an axial image.
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F3
Postoperative MRI demonstrated a small residual tumor at the Th8 (Figs. 3A and 3B).
Pathological studies. (A) Hematoxylin-eosin stained tumor from the second surgery, demonstrating the margin between the inner and outer tumor (x100). (B) The magnified photo in the yellow rectangle in A, x200). (C) Immunohistochemical studies demonstrated that staining for CD10 (C) and inhibin A (D). The inner portion of tumor was positive for CD10 and negative for inhibin A. The outer portion demonstrated opposite immunoprofile (CD10 negative and inhibin A positive).
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F4
The resected tumor from the second surgery consisted of stromal cells with an oval nucleus and a foamy cytoplasm and had two distinct regions between the tumor center and the margin (Figs. 4A and 4B). Immunohistochemistry revealed that the predominant tumor cells were positive for CD10 (Figs. 4C and 5A), PAX8 (Fig. 5B), vimentin, and AMACR in the inner tumor, which findings were compatible with RCC. However, the tumor cells were negative for CD31, CD34 (Fig. 5C), CK7 (Fig. 5D), and inhibin A (Figs. 4D and 5E), which findings indicated that the inner tumor was not hemangioblastoma. The outer tumor cells were partially positive for inhibin A (Fig. 4D); however, negative for CD10 (Fig. 4C).
Pathological studies. The inner portion indicating RCC. Immunohistochemical studies demonstrated that staining for CD10 (A) and PAX8 (B) were positive and CD34 (C), CK7 (D), and inhibin (E) negative in the inner tumor (x400). RCC: renal cell carcinoma.
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F5
Immunohistochemistry revealed that the predominant tumor cells were positive for CD10 (Figs. 4C and 5A), PAX8 (Fig. 5B), vimentin, and AMACR in the inner tumor, which findings were compatible with RCC. However, the tumor cells were negative for CD31, CD34 (Fig. 5C), CK7 (Fig. 5D), and inhibin A (Figs. 4D and 5E), which findings indicated that the inner tumor was not hemangioblastoma.