Paragangliomas in Cauda Equina Region: Clinicopathoradiologic Findings in Four Cases

ABSTRACT

OBJECTIVE: Four cases of non-secreting paraganglioma of the cauda equina are present with an emphasis on magnetic resonance (MR) images correlated with pathological features. METHODS: From 1973 to 2001, 703 patients with spinal cord tumors had been treated with surgery at our hospital. Among them, four patients had been diagnosed as paragangliomas, all of which occurred in the cauda equina. We analyzed clinical data, including medical records, radiological, and histopathological findings for four patients. RESULTS: Some findings may help us to differentiate spinal paraganglioma from other spinal tumors. The MR images of the tumor were generally nonspecific. However, tumor margins were hypointense on T2-weighted images and serpiginous flow voids were noted in the tumor. Histopathologically paragangliomas were composed of an organoid or `zellballen' arrangement of polyhedral and argyrophilic cells, circumscribed by a richly vascular stroma. Immunohistochemical examination showed positive reaction to synaptophysin, chromogranin, vimentin, neuron specific enolase, and S100 protein. CONCLUSION: Although it is difficult to make a correct diagnosis as paraganglioma preoperatively for the intradural extramedullary tumors, especially in the cauda equina, paraganglioma should be included in the differential diagnoses.