A 62 year old woman, complaining since some years of vague numbness and weakness of both legs getting worse in the last few months. Neurologic examination reveals only mild weakness of the right leg and bilateral painful disesthesias of both legs. Plain films of the lumbar spine demonstrate scalloping of the posterior margin of L4 with complete erosion of both pedicles of the same vertebra. CT and MR reveal a large space occupying lesion growing within the canal, apparently replacing or infiltrating the thecal sac, and producing marked widening of the canal, erosion of the posterior part of the vertebral body of L4, erosion-destruction of both pedicles and destruction of the lamina and facets on the right side. Differential diagnosis is not easy, since it is first of all difficult to precisely locate the lesion with respect to the thecal sac; it is in fact difficult to say whether the lesion is intra or extradural. Also the relationship with the bony structures is not clear: there is both evidence of remodeling (erosion) and infiltration and replacement (destruction). For these reasons the most common intradural lesions (ependymoma, neurinoma and meningioma) seem unlikely. A dermoid or epidermoid seems unlikely because of the signal on MR; primary bone tumors are unlikely, due to the secondary involvemnt of bone. A chordoma or a very rare paraganglioma have been taken into consideration. At surgery the bone of the posterior arch was definitely abnormal, being infiltrated by tumor. The tumor mass was soft, highly vascular, pink red. The lesion was both intra and extradural and occupied almost all the spinal canal at the level of L4. The nerve roots of the cauda were totally encased within the tumor that then could plot be totally removed. At histologic examination the tumor shows an organoid growth pattern characterized by regular nests and cords of cells, separated by vascularized connective tissue. Bony trabeculae are definitely infiltrated by neoplastic tissue. In some areas large cells of ganglion type are also found. The final diagnosis was: paraganglioma.
NEURORADIOLOGICAL-NEUROPATHOLOGICAL CORRELATIONS - CASE-5 - PARAGANGLIOMA
MORTINI , PIETRO;
1995-01-01
Abstract
A 62 year old woman, complaining since some years of vague numbness and weakness of both legs getting worse in the last few months. Neurologic examination reveals only mild weakness of the right leg and bilateral painful disesthesias of both legs. Plain films of the lumbar spine demonstrate scalloping of the posterior margin of L4 with complete erosion of both pedicles of the same vertebra. CT and MR reveal a large space occupying lesion growing within the canal, apparently replacing or infiltrating the thecal sac, and producing marked widening of the canal, erosion of the posterior part of the vertebral body of L4, erosion-destruction of both pedicles and destruction of the lamina and facets on the right side. Differential diagnosis is not easy, since it is first of all difficult to precisely locate the lesion with respect to the thecal sac; it is in fact difficult to say whether the lesion is intra or extradural. Also the relationship with the bony structures is not clear: there is both evidence of remodeling (erosion) and infiltration and replacement (destruction). For these reasons the most common intradural lesions (ependymoma, neurinoma and meningioma) seem unlikely. A dermoid or epidermoid seems unlikely because of the signal on MR; primary bone tumors are unlikely, due to the secondary involvemnt of bone. A chordoma or a very rare paraganglioma have been taken into consideration. At surgery the bone of the posterior arch was definitely abnormal, being infiltrated by tumor. The tumor mass was soft, highly vascular, pink red. The lesion was both intra and extradural and occupied almost all the spinal canal at the level of L4. The nerve roots of the cauda were totally encased within the tumor that then could plot be totally removed. At histologic examination the tumor shows an organoid growth pattern characterized by regular nests and cords of cells, separated by vascularized connective tissue. Bony trabeculae are definitely infiltrated by neoplastic tissue. In some areas large cells of ganglion type are also found. The final diagnosis was: paraganglioma.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
