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Fig 1. Patient 1. MR images of the thoracic spine and brain.
A, T2-weighted axial image of the thoracic spine in 1999 revealed an area of increased signal intensity changes in the spinal cord at the level of the T7 vertebral body (arrow). Enlargement of the spinal cord was not observed. Good sagittal MR images were not obtained, because of scoliosis.
B–G, Sagittal and coronal MR images of the thoracic spine in 2003 showed enlargement of the spinal cord between the level of T6 and T7 vertebral bodies, with hyperintensity on T2WI (B and E, arrows), isointensity on T1WI (C and F, arrows) and heterogeneous enhancement on T1WI obtained after an intravenous injection of contrast medium (D and G, arrows), which suggests an intramedullary tumor. Spinal cord atrophy was demonstrated at the upper and lower ends of the intramedullary tumor at the levels of T5 and T8 vertebral bodies on sagittal and coronal images (B–G, arrowheads). The tumor showed a "string of beads" appearance (B and E, asterisks).
H and I, Spinal cord atrophy was also confirmed on T2-weighted axial images at the levels of T5 and T8 vertebral bodies (arrowheads).
J, Photomicrograph of a specimen of the intraspinal tumor showed large round cells with clear cytoplasm and central nuclei (arrow) along fibrovascular septa. Small lymphocytes were not apparent (hematoxylin-eosin stain; original magnification, x66).
K, Photomicrograph of a specimen of the intraspinal tumor showed that the cell membrane (arrow), which stains brown, was immunoreactive for PLAP. Cell membrane expression of PLAP was characteristic of germinoma (placental alkaline phosphatase stain; original magnification, x132).
L and M, The left putamen was atrophic and showed high signal intensity change on T2WI (L, arrowhead). No contrast enhancement was observed on T1WI obtained after an intravenous injection of contrast medium (M, arrowhead). The presence of germinoma was suggested in the left putamen.
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