Granular Cell Tumor of the Intradural Extramedullary Spinal Cord : Report of Two Cases with Respect to Radiological Differential Diagnosis

Granular cell tumors (GrCTs) of the spinal cord are rare benign tumors with a high rate of local recurrence. Only 6 cases of spinal GrCTs have been reported. GrCT is difficult to distinguish from other benign tumors such as schwannoma using imaging. A radiological "speckled dots" sign may be a useful differentiating feature of GrCT based upon experience with two cases and a review of the literature.

Myelopathy due to Thoracic Intradural Extramedullary Tumor Misdiagnosed as the Cerebral Infarction: A Case Report

STUDY DESIGN: A Case report. OBJECTIVES: We report a case of thoracic intradural extramedullary tumor that has been misdiagnosed as the cerebral infarction. SUMMARY OF LITERATURE REVIEW: Spinal meningioma is one of the common spinal tumors. Clinical symptoms were characteristically progressive myelopathy, rather than radiculopathy. MATERIALS AND METHODS: A 66-year-old female patient who had a history of cerebral infarction admitted as suffering from progressive lower extremities weakness for 6 months. The patient was diagnosed and has been treated as the cerebral infarction at another hospital. However, the patient showed worsening symptoms. In magnetic resonance imaging, an intradural extramedullary space occupying mass compressing the spinal cord, between T8 and T9 level, was shown. By undergoing an operation, resected the mass. In a pathologic report, mass was confirmed to be meningioma. RESULTS: After the operation, symptoms were improved. The patient was able to walk 2 weeks after surgery. CONCLUSIONS: We report the correct diagnosis and a successful surgical treatment of myelopathy, due to thoracic myelopathy that has been misdiagnosed as the cerebral infarction in another hospital.

Intradural Extramedullary Ependymoma with Spinal Root Attachment: A Case Report

A 36-year-old female patient presented with shoulder pain experienced over a period of one year and progressive weakness in both legs for one month. A magnetic resonance imaging scan revealed an intradural extramedullary (IDEM) fusiform mass about 9.8 cm in length, heterogeneously enhanced at the level of C6-T4 with spinal cord compression. At the time of surgery, the surgeon found an encapsulated IDEM tumor with spinal root attachment. The tumor was completely resected and the histologic diagnosis revealed ependymoma. The patient showed a favorable outcome with no recurrence at the 6-month follow-up. This paper reports a rare case of intradural extramedullary ependymoma with spinal root attachment.

Capillary Hemangioma of the Thoracic Spinal Cord

Capillary hemangiomas are common soft tissue tumors on the skin or mucosa of the head and neck in the early childhood, but very rare in the neuraxis. A 47-year-old man presented with one month history of back pain on the lower thoracic area, radiating pain to both legs, and hypesthesia below T7 dermatome. Thoracic spine MRI showed 1x1.3x1.5 cm, well-defined intradural mass at T6-7 disc space level, which showed isointensity to spinal cord on T1, heterogeneous isointensity on T2-weighted images, and homogeneous strong enhancement. The patient underwent T6-7 total laminotomy, complete tumor removal and laminoplasty. Histologically, the mass showed a capsulated nodular lesion composed of capillary-sized vascular channels, which were tightly packed into nodules separated by fibrous septa. These features were consistent with capillary hemangioma.

Neurologic Complication Following Spinal Epidural Anesthesia in a Patient with Spinal Intradural Extramedullary Tumor

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.

The Surgical Treatment for Spinal Intradural Extramedullary Tumors

BACKGROUND: We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors. METHODS: The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred. RESULTS: The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r2 = 0.75, p = 0.010, Nurick's grade; r2 = 0.69, p = 0.019). One case of schwannoma recurred. CONCLUSIONS: The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.

Diagnosis and surgical treatment of subdural-extramedullary tumor / 中国矫形外科杂志

[Objective]To investigate the diagnosis,surgical procedure and clinical effect for the subdural extramedullary tumor. [Methods]Forty-five patients (28 males and 17 females,age ranged from 24-71 years with an average of 45 years ) were treated with tumour extirpation. MRI showed subdural extramedullary tumor before surgery. The spine was exposed through a standard posterior approach,and the dura matter was opened after lamninectomy. The tumor was separated and removed from the dura matter. Pedicle screw fixation was performed to restore the stability of spine. [Results]The patients were followed up from 6 to 42 months with an average of 26.2 months. The postoperative recovery of neurological function was measured with Otani scores. The clinical result was excellent in 11 patients,good in 18 and fair in 12,resulting in 64.44% of good to excellent rate. The good to excellent rate had an advantage in patients (84.62%) operated on within one month after first visit over that of patients (64.29%) who had a misdiagnosis for 1~6 months and the patients (50.00%) for more than 6 months.[Conclusion]Removal is the method of choice for patients with subdural extramedullary tumor. Early diagnosis and removal are key factors to get a good clinical effect.

Cervical Subependymoma Presenting as an Extramedullary Tumor

A rare case of cervical subependymoma in a 45-year-old man is described. The tumor appeared as an extramedullary mass lesion, but a discrete, less well-demarcated portion was observed in the anterolateral part of the cord at the C3-C7 level. Previous reports of spinal subepnedymomas are reviewed, and nosological possibilities of extramedullary presentation are discussed.

A Case of Gastric Extramedullary Tumor after Lymphoblastic Crisis in a Patient with Chronic Myelogenous Leukemia / 대한소화기내시경학회지

A localized extramedullary tumor mass composed of immature cells has been reported in association with acute myeloid leukemia, myeloproliferative disorders, myelodysplasia in blast transformation or chronic myeloid leukemia with trilineage hematopoiesis, as well as in patients with no known hematological disorder. Although this tumor may involve anywhere in the body and give rise to a variety of signs and symptoms, there are several case reports of extramedullary tumor in Korea which described the involvement of the gastrointestinal tract. We report the occurrence of gastric extramedullary tumor and lymphoid blast crisis in a patient with complete remission after lymphoblastic transformation of chronic myelogenous leukemia. Endoscopic biopsy for gastric elevated lesion showed diffuse lymphoblast infiltration with TdT (terminal deoxynucleotidal transferase) and CD20 positive immature cells.

Lumbar Epidermoid Inclusion Cyst after Single Spinal Puncture: A case report / 대한척추외과학회지

Epidermoid tumors of the central nervous system are infrequent(2%) and can occur congenitally or iatrogenically. Since Choremis et. al. reported intradural-extramedullary epidermoid tumor after repeated lumbar puncture, several cases have been reported. We experienced a case of epidermoid inclusion cyst after single lumbar puncture in a 7-year-old boy and report the clinical and radiologic findings with relevant literatures.

Case Study of A Cauda Equina Meningioma: Case Report

Spinal meningiomas are most commonly found in the thoracic sections while it is extremely rare in the cervical, lumbar and sacral regions. In Elsberg's series, there were 10 cervical, 59 thoracic and 4 lumbar ; none below the 3rd lumbar segment. Recently, we encountered a case of cauda equina meningioma and was completely extirpated with no remnants of any neurological deficits.