PMC7656021_01
Magnetic resonance imaging of thoracic spines. (a) Sagittal plane T1-weighted section. (b) T2-weighted section. (c) Contrast-enhanced T1-weighted section. (d) Axial plane T1-weighted section. (e) T2-weighted section. (f) Contrast-enhanced T1-weighted section. The images show an oval extramedullary intradural mass lesion (3.0 x 1.6 cm in size) at T10-11 lying to the right posterolateral aspect of the spinal cord. The lesion shows heterogeneous low signal intensity on T2W images and iso- to low signal intensity on T1W images with moderate heterogeneous enhancement.
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F1
The vertebral/intracanalicular lesion was iso- to hypointense on T1W images and heterogeneous/low signal intensity on T2W images; it was also accompanied by a focal hyperintense cord signal [Figure 1]. The T1 contrast study further documented heterogeneous enhancement of the intracanalicular extramedullary intradural mass (measuring 3.0 x 1.6 cm in size). At surgery, the lesion was chalky/white, invaded the ligamentum flavum, adhered to the dura mater, and compressed the cord. [Figure 2 and Video 1].
Intraoperative photographs. Intraspinal lesion (a) and Chalky white material firmly adherent to the dura mater (b) (see arrows). The dural sac after complete excision of the gout tophus (c).
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F2
At surgery, the lesion was chalky/white, invaded the ligamentum flavum, adhered to the dura mater, and compressed the cord. [Figure 2 and Video 1].
Microphotograph of histopathology showing acellular eosinophilia gouty tophi (G) surrounded by an inflammatory reaction and multinucleated giant cells (arrow) (H&E x 40).
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F3
The histological examination showed nodules and islands of an amorphous, basophilic material, surrounded by chronic inflammation, and multinucleated giant cell, all of which confirmed the diagnosis of tophaceous gout [Figure 3].