PMC10017122_01
Chronological magnetic resonance imaging (MRI) before surgery. A: T2-weighted MRI performed 24 months after the onset showed no specific findings around the conus medullaris. B: T2-weighted MRI performed 41 months after the onset showed spinal cord enlargement. C: T1-weighted enhanced MRI performed 41 months after the onset showed an intramedullary enhanced mass at the conus medullaris.
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A lumbar MRI performed 24 months after the onset did not suggest any specific findings around the conus medullaris (Fig. 1A). Lumbar MRI showed spinal cord enlargement and intramedullary mass lesions at the level of the 11th-12th thoracic spine (Fig. 1B, C).
Intraoperative photographs and pathological examinations. A: Swollen appearance of the spinal cord. B: Opening of the posterior median sulcus revealing the posterior surface of the intramedullary tumor. C: Gross total resection of the tumor. D: Hematoxylin and eosin staining shows a two-cell pattern consisting of the proliferation of round cells and lymphocytic infiltration. E: Immunostaining positive for placental alkaline phosphatase. F: Immunostaining positive for octamer-binding transcription factor 3/4. G: Immunostaining positive for c-kit.
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The spinal cord appeared swollen (Fig. 2A). The posterior median sulcus was identified and separated to reveal an intramedullary tumor (Fig. 2B). Finally, gross total resection of the tumor was performed (Fig. 2C). Immunostaining was positive for placental alkaline phosphatase, c-kit, and octamer-binding transcription factor 3/4, suggesting pure germinoma of the spinal cord (Fig. 2D-G).
Chronological MRI after surgery. A: T2-weighted MRI performed 7 days after surgery showed no obvious spinal cord enlargement or new mass lesions. B: T1-weighted enhanced MRI performed 7 days after surgery showed no obvious residual contrast-enhanced neoplastic lesions. C: T2-weighted MRI performed after chemotherapy and radiation showed no obvious spinal cord enlargement or new mass lesions. D: T1-weighted enhanced MRI performed after chemotherapy and radiation showed no obvious contrast-enhanced neoplastic lesions.
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Lumbar MRI on postoperative day 7 showed no obvious residual tumor, suggesting gross total resection of the tumor (Fig. 3A, B). Lumbar MRI after chemotherapy and radiation showed no apparent recurrence (Fig. 3C, D).