September, 2016 Edition. Volume XVI

In the examination and evaluation of any patient presenting with back or leg symptoms the possibility of spinal tumor must always be considered.  Clues as to the existence of a tumor are:

  • Pain which is worse at night.
  • Unexplained weight loss.
  • Neurologic examination showing a sensory level above the typical l3-S1 pattern.
  • Neurologic exam showing clonus, Babinski (or other long tract signs).

In today’s world the most effective means of tumor diagnosis is a high resolution MRI (Magnetic Resonance Imaging) scan.

Intradural Spinal Cord Tumors

4-20% of all primary central nervous system tumors are intradural.  Astrocytomas and ependymomas account for 80-90% of all intramedullary tumors while nerve sheath tumors (neurofibroma and schwannoma) and meningioma account for 80% of all intradural extramedullary tumors.

Schwannomas

These tumors are typically benign and, in the majority of cases, can be surgically removed.  In the case shown below a standard MRI examination shows the tumor mass arising from the cauda equina.  A digitally enhanced MRI better demonstrates the solid and cystic characteristics.  Tumor was completely excised and patient experienced no post-operative problems.

LumbSchwannoma01GIF LumbSchwannoma02GIF LumbSchwannoma03GIF

Meningiomas

Typically benign and well delineated from adjacent nerve tissue.  In this case the meningioma was identified with a myelogram.  Operative photo shows the well-defined tumor separate from the spinal cord (which has become markedly attenuated).  The histologic pattern was that of a psammomatous meningioma.  Patient experienced a complete recovery with no further problems.

PsamMeningT401 PsamMeningT402 PsamMeningT403

Extradural Spinal Column Tumors

Lymphomas

Lymphoma is a cancer of the lymph glands divided into Hodgkins and non-Hodgkins types.  The nature of the tumor is described as Type 1-4. Spinal lymphomas are usually secondary to tumors elsewhere in the body.  Following surgical decompression and pathologic review radiotherapy and chemotherapy are usually the initial forms of therapy.

ThorLymph01GIF200 ThorLymph02GIF200

In the case shown above the thoracic lymphoma produced spinal cord compression.  Surgical decompression was followed by radiation and chemotherapy.

PelvicLymphoma

Shown to the left is a lymphoma involving the pelvic rim (ileum) and the sacro-iliac joint. This tumor was responsive to both radiation and chemotherapy.

 

 

Mass Lesions Imitating Spinal  Cord Tumors

Synovial Cysts and Chondromas

These entities are mass lesions often acting just like tumor.  They are totally benign masses produced by  facet joint degeneration.  The mass is similar to a “ganglion” of the wrist joint but in a “bad” location.  Although benign these masses may compress spinal nerves or the spinal cord.  In the example shown the mass (at the thoracic 11-12 level)  required surgical removal.  This mass presented clinically much like a spinal cord tumor.

ThorSynChond01GIF200 ThorSynChond02GIF200

MRI Synovial Chondroma Synovial Chondroma 300p

Shown immediately above is a L4-5 level synovial chondroma which was complicating a Grade 1 degenerative spondylolisthesis and an associated central spinal stenosis.  The post-operative specimen is on the right and was acting very much like a tumor.

Burton Report is an independent and non-commercial internet journal which was first published on January 1, 2000 and is dedicated to the principle that health care and the health care process MUST reflect truth and integrity as well as the best interests of the patient.

The information presented in Burton Report is intended for dissemination without alteration.

© Burton Report® 2000-2016, All Rights Reserved