PMC4685124_01
Axial sections of the brain: (a) T1 weighted and (b) T2 weighted images showing mild effacement of the sulci. Positive phase shift and blooming along the sulcal spaces (arrow heads) on (c) phase and (d) MIP (susceptibility weighted) images suggestive of superficial siderosis.
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T2 weighted images (T2WI) (Figures 1(a) and 1(b)). There was a positive phase shift and blooming along the sulcal spaces on phase contrast and maximum intensity projection (MIP) susceptibility weighted images (arrow heads in Figures 1(c) and 1(d)) suggestive of superficial siderosis. There was no evidence to suggest the possible source of haemorrhage in the MR images of the brain. The remainder of general physical and systemic clinical examination was also unremarkable.
Sagittal sections of the cervical vertebral column: (a) T2 weighted and (b) T1 weighted images showing an intradural extramedullary mass which appears hypointense on T2 weighted image and hyperintense on T1 weighted image. (c) Postcontrast fat saturated T1 weighted and (d) subtracted contrast image showing mild peripheral heterogeneous enhancement of the tumor since the true enhancement pattern was obscured by the strong T1 hyperintensity of the mass on unenhanced images.
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Cervical spinal magnetic resonance imaging (MRI) revealed an intradural extramedullary mass occupying the anterior intradural space which displayed hypointense signal on T2WI and hyperintense signal on T1WI (Figures 2(a), 2(b), 3(a), and 3(b)). Contrast enhancement of the mass was not evidently revealed by visual assessment on postcontrast fat saturated T1 weighted images (Figure 2(c)) due to strong T1 hyperintensity of the mass on unenhanced images. Mild peripheral heterogeneous enhancement of the tumor was verified by the subtracted images (Figure 2(d)).
Axial images of the cervical vertebral column: (a) T1 weighted and (b) T2 weighted images showing an intradural extramedullary mass (arrow) occupying the anterior intradural space, compressing and displacing the spinal cord posteriorly. (c) On postcontrast fat saturated T1 weighted images the lesion shows peripheral heterogeneous enhancement.
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Cervical spinal magnetic resonance imaging (MRI) revealed an intradural extramedullary mass occupying the anterior intradural space which displayed hypointense signal on T2WI and hyperintense signal on T1WI (Figures 2(a), 2(b), 3(a), and 3(b)). The lesion was compressing and displacing the spinal cord posteriorly (arrow in Figures 3(a), 3(b), and 3(c)).
PET image showing moderately FDG avid intradural mass lesion (arrow).
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The PET CT images showed moderately FDG avid extramedullary intradural mass (arrow in Figure 4) and no other foci of FDG avidity were noted elsewhere in the body.
Histopathological examination. (a) Diffusely pigmented tumor with peritheliomatous arrangement which obscured the cytological details (H and E 40x). (b) After bleaching, tumor had pleomorphic round to oval nuclei with inconspicuous nucleoli and moderate amount of cytoplasm (H and E 40x). (c) Tumor on higher magnification had mild nuclear pleomorphism, moderate to abundant cytoplasm with few containing blackish brown pigment. No significant increase in mitosis was seen (H and E 200x).
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Hence the lesion was treated as primary cervical spinal melanocytoma which was confirmed on histopathological examination which revealed diffusely pigmented tumor with peritheliomatous arrangement which obscured the cytological details (H and E 40x) (Figure 5(a)). After bleaching, tumor had pleomorphic round to oval nuclei with inconspicuous nucleoli and moderate amount of cytoplasm (H and E 40x) (Figure 5(b)). No significant increase in mitosis (<1 mitosis per 10 high power fields) was seen (H and E 200x) (Figure 5(c)).