PMC4408617_01
Preoperative sagittal MRI (a) T1 and (b) T1+ Gadolinium showing homogeneous enhancement (c) T2 showing an isointense to mildly hyperintense lesion
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F1
On T1-weighted images, the lesion was isointense to the cauda equina [Figure 1a]. After gadolinium administration, the lesion showed avid homogeneous enhancement [Figure 1b]. On T2-weighted imaging, the lesion appeared isointense to mildly hyperintense to the cauda equina [Figure 1c].
MRI T1+Gadolinium (a) Preoperative axial image (b) Postoperative showing gross total resection (c) Preoperative sagittal image (d) Postoperative image showing improved cauda equina mass effect
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F2
Postoperative MRI of the lumbar spine showed a gross total resection of the intradural lesion [Figure 2a-d].
Histologic features of the neoplasm. (a-c) Hematoxylin and eosin stain. (d) CD31 immunostain. (e) CD34 immunostain. (f) Inhibin immunostain. Magnification: a: x40, b: x100, and c-f: x400
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F3
Microscopic examination showed a well-encapsulated, highly vascular lesion [Figure 3a] that appeared lobulated by fibrous septae with numerous capillaries [Figure 3b]. The neoplasm was composed predominantly of small blood vessels lined by a single layer of oval cells, with sizes ranging from capillary-like to ectatic [Figure 3c]. The neoplastic cells were immunoreactive to CD31 [Figure 3d] and CD 34 [Figure 3e], confirming their endothelial nature. The neoplastic cells were negative for inhibin [Figure 3f] and epithelial membrane antigen (EMA), thus eliminating the possibility of hemangioblastoma and meningioma, respectively.