PMC7371922_01
Preoperative cervical MRI of the patient (upper). (A) Sagittal T1-weighted imaging showed strip-shaped hypointensity along the anterior and posterior borders of the spinal cord at the C5-T4 levels. (B) Sagittal T2-weighted imaging showed strip-shaped hyperintensity along the anterior and posterior borders of the spinal cord at the C5-T4 levels. (C) Contrast-enhanced T1-weighted imaging showed linear enhancement at the C5-T4 levels (red arrows). Cervicothoracic MRI of the patient after symptom aggravation (lower). (A) Sagittal T1-weighted imaging showed strip-shaped hypointensity along the anterior and posterior borders of the dural sac at the T1-T6 levels. (B) Sagittal T2-weighted imaging showed strip-shaped hyperintensity along the anterior and posterior borders of the dural sac at the T1-T6 levels. (C) Contrast-enhanced T1-weighted imaging showed linear enhancement along the anterior and posterior borders of the dural sac at the T1-T6 levels (red arrows).
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F1
C5-T4 levels (Figure 1, upper). Cerebrospinal fluid (CSF) examination via a lumbar puncture showed faint-yellow fluid with a normal pressure of 130 mmH2O. Cervicothoracic MRI revealed strip-shaped abnormal signals along the anterior and posterior borders of the dural sac at the T1-T6 levels (Figure 1, lower).
Histopathological and immunostaining examination of the thoracic subdural lesion which was resected. Hematoxylin-eosin staining showed numerous plasma cell infiltrates within the fibrofatty tissue (A x 200; B x 100) (black arrows). Plasma cells were positive for immunoglobulin G (IgG) (C) and IgG4 (D) (C x 400; D x 400) (white arrows).
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F2
Histopathological examination showed diffuse infiltration of inflammatory cells within the fibrofatty tissue, and numerous plasma cell infiltrates could be noted (Figures 2A,B). Focally, more than 10 IgG4-positive plasma cells could be seen per high-power field (HPF) (Figures 2C,D).