PMC6213809_01
MRI of the lumbar spine. (a) Sagittal postcontrast scan showing an enhancing mass at the L2-3 level. (b) Axial postcontrast scan showing a right-sided mass extending into the right neural foramen causing foraminal expansion and canal stenosis. (c) Axial T2 showing severe central stenosis
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F1
MRI of her lumbar spine with and without contrast showed an enhancing extradural mass at the L2-L3 level extending into the right neural foramen, contributing to severe central and right L2-L3 foraminal stenosis [Figure 1]. MRI studies of the cervical and thoracic spine were negative, as was the CT of her chest, abdomen, and pelvis.
Postoperative MRI. (a) Sagittal contrast enhancing scan showing residual tumor ventral to the thecal sac. (b) Axial contrast-enhancing scan showing residual tumor extending laterally into the neural foramen. (c) Axial T2 image showing adequate decompression of the thecal sac
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F2
The postoperative lumbar MRI showed the thecal sac, and neural elements at the L2-L3 level was adequately decompressed [Figure 2].
Histopathology slides. (a) Hematoxylin and eosin showing mixture of inflammation and fibrosis. (b) Hematoxylin and eosin showing areas of more extensive mononuclear inflammation. (c) CD3, numerous T-cells. (d) CD20, relatively fewer B-cells. (e) CD138, heavy plasma cells. (f) Kappa light chain. (g) Lambda light chain. (h) IgG. (i) Scale bar = 50 microns; IgG4
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F3
Rather, the final pathology report showed dense mixed lymphoplasmacytic and histiocytic inflammatory infiltrate with marked stromal fibrosis and a large number of IgG4+ plasma cells with an IgG4/IgG ratio of 27% [Figure 3].