PMC8168660_01
Preoperative T2-weighted noncontrast MRI (left) of an isointense intradural extramedullary lesion extending from the level of C1-C2 measuring 1.5 x 1.6 x 3.5 cm (TV x AP x CC), causing severe mass effect and signal changes in the spinal cord. Postoperative T2-weighted noncontrast MRI (right) after C1-C3 laminectomy with revision and posterior arch of C1 resection. No evidence of residual mass or abnormal enhancement is seen. The spinal cord has significantly reexpanded with hyperintensity noted within the cord.
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F1
The lesion spanned adjacent from vertebral bodies of C1-C3 causing severe compression with kinking at the level of the C1-C2 foramen [Figure 1].
Intraoperative image of pigmented lesion and hemorrhage.
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F2
The mass was removed in a piecemeal fashion under the microscope [Figure 2].
Preoperative T1 sagittal MRI with contrast (a). Postoperative T1 sagittal MRI with contrast (b). Preoperative T1 axial MRI with contrast (c). Postoperative T1 axial MRI with contrast (d).
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F3
Preoperative and postoperative imaging changes are found in [Figure 3].
Immunohistochemistry. Hematoxylin and eosin (H and E) stained section reveals a tumor whose cells have ample pale, vacuolated cytoplasm and large pleomorphic nuclei with prominent nucleoli. Some tumor cells contain melanin pigment, and lymphocytic reaction is visible around a small venule (a). Immunohistochemical stains for S-100 (b), HMB-45 (c), and MelanA/MART1 (d). Confirmation of the melanocytic origin of the neoplasm. Scale bars in all panels represent 25 micrometers.
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F4
Histopathological evaluation of the lesion revealed a malignant melanoma with S-100, HMB45, Mart-1, and vimentin positivity and BRAF negativity [Figure 4]. She then underwent a C2-C6 posterior cervical fusion with C2 pars screws and lateral mass instrumentation from C3-C6 [Figure 4]. Radiology revealed satisfactory cervical alignment with a slight reversal of normal cervical lordosis 2 weeks following fusion [Figure 4].
Preoperative lateral cervical spine radiograph (left) shows postlaminectomy kyphosis, postoperative imaging (right) shows C2-C6 posterior cervical instrumentation which achieved correction of kyphosis.
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F5
The X-ray revealed postlaminectomy kyphosis [Figure 5].