PMC9168293_01
Preoperative axial (a) and sagittal (b) thoracic spine MRI sequences showed a T7-T9 intradural extramedullary dumbbell-shaped lesion with intense post contrastographic enhancement. Also, this lesion appears hypointense on T2-weighted images (c) and hyperintense on STIR sequences (d).
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F1
T9 (i.e., maximal width T8) levels contributing to severe spinal cord compression [Figures 1a-d]. This lesion was hypointense on T1/T2-weighted images [Figure 1c], hyperintense on STIR sequences [Figure 1d], and intensely enhanced with contrast [Figures 1a and b]. The whole-body PET-CT-scan revealed multiple diffuse osteoblastic lesions, and the high level of a radioactive tracer involving the 8th/9th ribs bilaterally, sternum, pelvis, and C6-C7 and T3 pedicles. Immunostaining showed a positive check for chromogranin and synaptophysin [Figures 3a and b] [Table 1].
Postoperative sagittal thoracic spine MRI sequences showed a complete endospecal removal of the lesion images on STIR (a) and T2 sequences (b).
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F2
The 1-week postoperative thoracolumbar MRI documented complete removal of the extradural tumor [Figures 2a and b].
Immunostaining showed the two most specific and sensitive markers capable of defining the neuroendocrine nature of the neoplasm: Synaptophysin: diffuse and intense cytoplasmic positivity in about 90% of neoplastic cells. (a) Chromogranin-A: granular cytoplasmic positivity (dot-like) in about 90% of neoplastic cells (b).
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F3
Immunostaining showed a positive check for chromogranin and synaptophysin [Figures 3a and b] [Table 1].
Hematoxylin and eosin stain image showed nuclear atypia, with diffuse "salt and pepper" chromatin.
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F4
The combination of studies allowed for documentation of a well-differentiated neuroendocrine neoplasm (i.e., NEN sec WHO 2019) [Figure 4].