Case 002

History/Physical

History/Physical:

64-year-old left-handed female.

Gradual onset of leg weakness over 2 years.

Increased reflexes in lower extremities.

Upgoing toes.

On the unenhanced sagittal T1, there is a well-defined mass in the spinal canal at C5/6 (*). There is a cleft between the mass and the spinal cord (arrow), suggesting the mass is extra-medullary.

The mass enhanced heterogeneously on the axial T1 + contrast (*). The spinal cord is displaced to the left (arrowhead). Again, there is a clear plane between the mass and the cord (arrow), suggesting this lesion is extra-axial.

In comparison to the unhanced T1 sequence, the mass clearly enhances (*). There is dural enhancement above and below the mass (arrows). This is known as a 'dural tail'. Fat is hyperintense on T1. The subcutaneous fat (arrowhead) is low signal as fat saturation was added to the T1 sequence so that enhancement is more conspicuous.

Diagnosis: Psammomatous meningioma

Lobular tumour with prominent, round, laminated calcifications (psammoma bodies, arrow).

Tumour cells have oval, monotonous nuclei with occasional intranuclear pseudoinclusions (arrow). Areas display a syncytial architecture with indistinct cell borders.

Focal membranous expression (arrow) of Epithelial Membrane Antigen (EMA).
Vimentin (strong, diffuse) and S100 protein (light, diffuse) were also expressed (not shown).