PMC9929664_01
Initial MRI brain/whole spine: (A) High signal change along cervical spinal cord on T2 weighted sagittal slice. (B) Focal contrast enhancing lesion at C3/4 level seen on T1 weighted fat-saturation pulse sequence sagittal slice. (C) Lesion on T2 weighted axial slice. (D) Lesion seen on T1 weighted fat-saturation pulse sequence axial slice. Red arrows point to lesion. MRI, magnetic resonance imaging.
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Initial imaging performed, magnetic resonance imaging (MRI) brain/whole spine (June 2021) (Figure 1), showed an expanded cervical spinal cord with high signal change and oedema from the craniocervical junction to T1 level.
Interim MRI brain/whole spine. (A) Focal enhancing lesion and surrounding cord oedema on T2 weighted sagittal slice. (B) Lesion seen on T1 weighted fat-saturation pulse sequence sagittal slice. (C) Lesion seen on T2 weighted axial slice. (D) Enlargement of choroid plexus in left lateral ventricle with ependymal enhancement and extension into thalamic region on T2 weighted axial slice of brain at mid-level of lateral ventricles. Red arrows point to lesion. MRI, magnetic resonance imaging.
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Interval imaging was performed, MRI brain/whole spine (October 2021) (Figure 2), which showed disease progression in the cervical spine with enlargement of the contrast enhancing spinal cord lesion to the mid-point of C5.
Intraoperative photographs. (A) Thickened dura. Dural window shows area of spinal cord with relative absence of surface vascularity. (B) Vascular lesion seen on opening spinal cord.
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The cord generally had good vascularity with a small area where surface vessels were absent as seen in Figure 3.
Histology photographs. (A) Hematoxylin and eosin stain: large lymphoid cells. Scale bar: 50 microm. (B) Immunohistochemistry: CD20 marker positivity. Scale bar: 50 microm. (C) Immunohistochemistry: Ki67 proliferation marker. Scale bar: 50 microm. (D) In-situ hybridization: EBER-ISH marker. Scale bar: 50 microm. EBER-ISH, Ebstein-Barr encoded ribonucleic acid in situ hybridization.
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  Microscopic (Figure 4): glial tissue with infiltrate of large lymphoid cells with irregular nuclei and prominent nucleoli with abundant mature lymphocytes, histiocytes and plasma cells.