PMC2817645_01
Preoperative MRI: sagittal (a) and axial (b/c) T1 weighted image with contrast showing the intramedullary gadolinium-enhancing lesion at level T5-T6.
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F1
One month after the first MRI, during recovery, she underwent another dorsal MRI with contrast, which confirmed the presence of this intramedullary gadolinium-enhancing lesion at level T5-T6: this was interpreted as hemangioblastoma or ependymoma but, according to the neuroradiologist, it was impossibile to exclude other diagnostic hypothese (fig.1).
1a/b Cytoplasmic immunoreactivity for CD68 is evident. 2a/b -The lesion is composed of a mixture of lymphocytes with plasmacells and macrophages. In figure b a granulomatous reaction is evident.
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F2
Also the non-neoplastic nature of the lesion was demonstrated by immunohistochemical studies, which confirmed the mixed nature of lymphocytes, and by the polyclonality of plasma cells with positivity for kappa and lambda light chains of immunoglobulins (fig 2, 3).
A CD 68 reactivity - 3b Surface immunoreactivity for CD3. 4/5 ziehl- Neelsen reactivity and Surface immunoreactivity for CD20
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F3
Also the non-neoplastic nature of the lesion was demonstrated by immunohistochemical studies, which confirmed the mixed nature of lymphocytes, and by the polyclonality of plasma cells with positivity for kappa and lambda light chains of immunoglobulins (fig 2, 3).
Postoperative MRI: Sagittal T1 weighted image with gadolinium 10 days (a), 3 months (b), and 10 months (c) after surgery.
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F4
Postoperative dorsal MRI with contrast was performed 10 days after surgery and confirmed complete removal of the lesion without any signs of residual disease (fig.4a). At follow up thoracic MRI with contrast was performed 3 (fig.4b) and 10 months (fig.4c) after surgery, and did not show any signs of disease.