Common Spinal Tumors Research Articles

Epidemiological features of spinal intradural tumors, a single-center clinical study in Beijing, China

BackgroundSpinal intradural tumors are rare and heterogeneous in histological type, aggressiveness, and symptomatology, and there is a lack of data about them. This study investigated the epidemiological features of spinal intradural tumors.MethodsThis retrospective analysis included patients with spinal intradural tumors who underwent surgical treatment at the Myelopathy and Spondylosis Ward Beijing Jishuitan Hospital between January 2012 and December 2022.ResultsThis study included 1321 patients [aged 47.19 ± 14.90 years, 603 (45.65%) males] with spinal intradural tumors. The most common histological subtype was schwannoma [n = 511 (38.68%)], followed by spinal meningioma [n = 184 (13.93%)] and ependymoma [n = 101 (7.65%)]. Fifteen (1.14%) patients were diagnosed with metastatic spinal intradural tumors as a presentation of another primary cancer type. The spinal intradural tumors were mostly found in the lumbar region [n = 436 (33.01%)], followed by the thoracic vertebrae [n = 390 (29.52%)], cervical vertebrae [n = 154 (11.66%)], and thoracolumbar region [n = 111 (8.40%)]. Schwannomas mostly affected the lumbar region [n = 256 (52.64%)], spinal meningiomas in the thoracic region [n = 153 (83.15)], and ependymomas in the lumbar region [56 (55.45%)]. The de novo metastases were mostly found in the lumbar region [n = 8 (53.33%)].ConclusionAccording to the results of our single-center study, the most common spinal intradural tumor in Northern China is schwannoma, followed by spinal meningioma and ependymoma.

Predictors of Progression-Free Survival in Patients With Spinal Intramedullary Ependymoma: A Multicenter Retrospective Study by the Neurospinal Society of Japan.

Ependymoma is the most common spinal intramedullary tumor. Although clinical outcomes have been described in the literature, most of the reports were based on limited numbers of cases or been confined to institutional experience. The objective of this study was to analyze more detailed characteristics of spinal intramedullary ependymoma (SIE) and provide clinical factors associated with progression-free survival (PFS). This retrospective observational multicenter study included consecutive patients with SIE in the cervical or thoracic spine treated surgically at a total of 58 institutions between 2009 and 2020. The results of pathological diagnosis at each institute were confirmed, and patients with myxopapillary ependymoma, subependymoma, or unverified histopathology were strictly excluded from this study. Outcome measures included surgical data, surgery-related complications, postoperative systemic adverse events, postoperative adjuvant treatment, postoperative functional condition, and presence of recurrence. This study included 324 cases of World Health Organization grade II (96.4%) and 12 cases of World Health Organization grade III (3.6%). Gross total resection (GTR) was achieved in 76.5% of cases. Radiation therapy (RT) was applied after surgery in 16 cases (4.8%), all of which received local RT and 5 of which underwent chemotherapy in combination. Functional outcomes were significantly affected by preoperative neurological symptoms, tumor location, extent of tumor resection, and recurrence. Multivariate regression analysis suggested that limited extent of tumor resection or recurrence resulted in poor functional outcomes. Multiple comparisons among the groups undergoing GTR, subtotal resection and biopsy, or partial resection of the tumor showed that the probability of PFS differed significantly between GTR and other extents of resection. When GTR can be safely obtained in the surgery for SIE, functional maintenance and longer PFS can be expected.

Spinal Schwannoma as Pregnancy Related Spinal Tumor

Spinal schwannoma is the most common benign spinal tumors that originated from peripheral nerve sheath tumors. Male and females are equally affected. Due to hormonal imbalance during pregnancy, it might affect the release of the tumor-growth factor. The symptoms usually start with pain and sensory loss at the spinal cord level. We report a case of thoracolumbar schwannoma with a history of chronic low back pain since post-pregnancy. A Thirty-Seven years old female, suffered chronic low back pain for 3 years since she had a pregnancy. In the last 4 months, she suffered paresis and tingling sensation on the right foot. MRI shown intradural mass at Th 12 – L2. Biopsy, tumor resection, and laminectomy were performed to do the histopathology analysis, resect, and stabilization. Histopathology examination revealed Schwannoma types. The patient was discharged three days after complete tumor resection and stabilization, with an improvement of neurological function. Spinal Schwannoma can occur as a Pregnancy-related spinal tumor (PRST), it can be diagnosed during pregnancy or within a year after delivery. The incidence is rare, therefore proper workup and early examination are needed and followed by careful and considerate treatment.

Primary extranodal natural killer/T-cell nasal-type lymphoma of spine

Rationale:Primary Extranodal Natural Killer/T-Cell Nasal-Type Lymphoma (ENKTCL) of spine is rarely reported. This case study presents a rare case of ENKTCL originating from the sixth thoracic vertebra.Patient concerns:Here, we present a case of 49-year-old Asian male with chest and back pain. Physical examination revealed the myodynamia of both lower limbs decreased from IV degree to 0 degree, reflexes of both lower limbs and a large area of cutaneous sensation below xiphoid process disappeared in 3 days.Diagnoses:In immunophenotype analysis, CD2, CD3, CD7, and CD68 were positive and CD56 was suspiciously positive. Granzyme B and T-cell intracellular antigen (TIA-1) were also positive and in situ hybridization was positive for Epstein–Barr virus–encoded mRNA (EBER). Ki-67 was 60%+. Nuclide bone scan showed that the nuclide was unusually concentrated in the sixth thoracic vertebra which considered extremely active and slightly concentrated in the right sacrolilac joint. Magnetic resonance imaging detected an abnormal signal in the sixth thoracic vertebra with corresponding paravertebral and intraspinal occupying lesion. Based on the above features, a diagnosis of ENKTCL was made.Interventions:This patient was treated with surgery and symptomatic supportive treatment.Outcomes:The myodynamia of patient's both lower limbs were elevated to I degree after the operation with chest and back pain partly relieved. However, the patient died about 3 months later.Lessons:ENKTCL could originate from spine. Clinicians should be alert for early stage diagnose and distinguish it from some common spinal tumor such as neurofibroma and hemangioma.

Adrenal Cortical Adenoma in the Spinal Canal: A Case Report and Review of the Literature

Ectopic adrenal cortical neoplasms of the spinal cord are extremely rare. To date only 10 such cases have been described. We present a case of a 46-year-old woman with lower back pain radiating to the right gluteal and posterior femoral regions, without a history of traumatic injury. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine showed an intradural, extramedullary, well-circumscribed, contrast-enhancing lesion located in the T12-L1 region, hypo- to isointense on T2-weighted imaging, and isointense on T1. Complete surgical removal of the lesion, measuring 3 × 2.5 × 1 cm, was performed. The histopathologic findings revealed the lesion was an ectopic adrenal cortical adenoma, with sheets and nests of round and polygonal cells, mostly round regular nuclei, abundant eosinophilic cytoplasm, 1 mitosis per 10 high-power fields, and without necrosis. These tumors have nonspecific MRI features and therefore can be easily confused with other common spinal tumor types such as ependymoma, schwannoma, meningioma, and metastasis. Although rare, ectopic adrenal spinal cord adenomas should be taken into account in the differential diagnosis of spinal canal intradural neoplasms.

Spinal tumors in children.

Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Multimodality radiological studies (plain films, 3D computed tomography scan and magnetic resonance imaging) are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis. As a general rule, a fine needle biopsy is recommended after radiological evaluation to confirm the tumor's histology. Primary bone tumors can be divided into benign bone tumors, mostly represented by vertebral hemangiomas, osteoid osteomas, osteoblastomas, aneurismal bone cysts, and eosinophilic granulomas, and malign or aggressive tumors, such as Ewing's or osteogenic sarcomas. Secondary bone tumors (spinal metastases) comprise different tumor histologies, and treatment is mainly based on tumor's radiosensitivity. The characteristics and treatment options of the main spinal tumors are discussed in details. Spinal tumors in children are rare lesions that demand a thorough understanding of their main characteristics for their proper management. Understanding the nuances of spinal tumors in children is of paramount importance for improving outcomes and chances of cure.

Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Remarks on 173 Cases.

Spinal meningiomas are common spinal tumors, in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring a less favorable prognosis. To correlate these data with clinical/functional outcome. Two hundred twenty-four consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these, 51 were excluded for incomplete clinical data or follow-up. The remaining 173 cases were classified in regards to sex, age, symptoms, axial location, Simpson grade resection, and functional pre-/postoperative status. Most recurring onset symptoms were pain (32.9%) and motor deficit (31.8%); thoracic spine was the most severely affected (69.8%). Functional improvement on the follow-up was observed in 86.7% of cases; 6.4% of patients resulted stable and 6.9% worsened. A low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grades I and II) was conducted in 98.8%, and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. Of the meningiomas, 98.3% were classified as WHO grade I. Recurrence rate was 2.3%, and 7 cases presented complications (4 of 7 required surgical procedure). We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.

An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases

IgG4-related disease is relatively new disease entity and a rare one, and our knowledge of this entity continues to evolve. It was first described in the pancreas and since then has been described in virtually every organ. Spinal involvement resulting in pachymeningitis is rare, and there are only 8 reported cases of the same to date, with the cervicothoracic spine being the most commonly affected region. The authors describe 2 cases in which the patients presented with spinal compression resulting in myeloradiculopathy (Case 1) and radiculopathy (Case 2). Imaging of spine in both cases revealed an ill-defined contrast-enhancing lesion at the lumbar level. Preoperatively, a diagnosis of spinal tumor was made, but intraoperatively no spinal tumor was found. The diagnosis was established histopathologically. The disease has no particular defining features clinically or radiologically and can mimic common spinal tumors. It is important to accurately diagnose this rare entity because of its multisystem involvement and progressive course. Strict treatment guidelines have yet to be formulated. Although histologically this disease can mimic other inflammatory conditions, the presence of storiform fibrosis and an increased number of IgG4-positive plasma cells can help in clarifying the diagnosis.

Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Clinical and Surgical Remarks on 173 Cases

Introduction Spinal meningiomas are common spinal tumors in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement or spinal root involvement can bring to a less favorable prognosis. Aim of this work is to systematically the influence of this factors in the neurological outcomes of our patients. Matherial and Methods 224 consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these 51 were excluded for incomplete clinical data or follow up. The remaining 173 cases were classified regarding to: sex, age, symptoms, axial location, Simpson Grade resection, Functional pre/postoperative status. Results Most recurring onset symptoms were pain (32,9%) and motor deficit (31,8%); Thoracic spine was the most severely affected (69,8%). The functional improvement on the follow up was observed in 86,7% of cases, 6,4% of patients resulted stable and 6,9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42,2%); a gross total resection (Simpson Grade I and II) was conducted in 98,8% and a macroscopically complete removal without dural resection or coagulation (Simpson III) was performed in 1,2%. 98,3% of meningiomas were classified as Grade I WHO. Recurrence rate was of 2,3% and 7 cases presented complications (4 of 7 required surgical procedure). Conclusions We can adfirm that negative prognostic factors in our study were: anterior or antero-lateral axial topography, long-lasting symptoms before diagnosis, WHO Grade > I, Simpson Grade resection II and III, sphincter involvement and worse functional grade at onset.

Findings from frozen sections of spinal subependymomas: Is it possible to differentiate this diagnosis from other common spinal tumors?

Subependymomas are slow-growing, benign neoplasms that are rarely found in the spinal cord. Because of the differences in the treatment plans, it might be very helpful for neurosurgeons to intraoperatively establish a diagnosis of spinal subependymoma, differentiated from other spinal intramedullary tumors. In this study, we analyzed frozen sections of spinal subependymomas to identify potential histological clues of spinal subependymomas to differentiate them from tumors that mimic spinal subependymoma. We reviewed the frozen sections and the corresponding permanent slides for 7 cases of spinal subependymoma. The spinal subependymomas showed several characteristic patterns, including, most importantly, an eccentric or both central and eccentric location in the axial plane. Histologically, they showed a (1) well-demarcated and multinodular mass with (2) low or moderate cellularity, (3) a microlobular pattern, and (4) small clusters of neoplastic cells. These features appear to be very specific to spinal subependymomas and could help differentiate them from ependymomas or astrocytomas. Although we might not be able to provide an exact diagnosis of all spinal subependymomas using these histological features, we hope that they help neuropathologists and neurosurgeons to adequately diagnose and treat spinal subependymomas.

One-stage Combined Approach to “Dumbbell” Neurogenic Tumor

Mediastinal “dumbbell” tumors are constricted at the point they penetrate the intervertebral foramina or dura mater andassume an hourglass shape. Nowadays, the term is used as a conceptual term meaning separate tumors that connect andhave two or more separate regions such as intradural space, epidural space, and mediastinum. Because of their variedlocations, dumbbell tumors have variable features, clinical symptoms, and pathological characteristics different from commonspinal tumors, and therefore, their surgical treatment is also different. A 51-year-old female presented with ambiguousnumbness on her right lower back. Clinical studies revealed a large mediastinal mass in the posterior mediastinum whichpenetrated the vertebral foramen of the eleventh thoracic vertebra and was composed of dumbbell tumor. We completelyexcised the tumor through one-stage combined approach by thoracic surgery and neurosurgery.

Clinical and radiological presentation of spinal epidural haemangiomas: clinical series in a tertiary care centre during a 10-year period

Haemangiomas are very frequent benign spinal tumours. However, pure epidural location is extremely rare. At present, only 52 cases have been reported in the literature during the last 10years. We proposed to analyse clinical and radiological features of this rare entity treated in a tertiary care centre over the last 10years. A study of a retrospective surgical series (2002-2012) was conducted. The clinic's electronic database was searched for "spinal" and/or "vertebral haemangiomas", which were treated by surgery and/or vertebroplasty. Clinical, radiological and histopathological data were analysed. In total, the series comprised 30 spinal haemangiomas. There were 6 epidural (20%), 17 vertebral (57%) and 7 intradural lesions (23%). There were four men and two women, mean age 28.3years, with epidural lesions. One patient presented with localised back pain only, two with radiculopathy and focal neurological deficit, two with radiculopathy only and one with isolated focal neurological deficit, respectively. The onset of symptoms was progressive in four cases over weeks to months and sudden in two cases. Preoperative MRI imaging revealed features of meningioma, neurinoma or metastasis. Epidural haemangiomas are extremely rare spinal lesions. They may mimic more common spinal tumours clinically and radiologically. The usual treatment is gross total resection confirming the diagnosis histologically.

Imaging of Cervical Extradural En-Plaque Meningioma

Meningioma is one of the most common spinal extramedullary tumors, largely intradural. An extradural localization is possible but less frequent. There are two morphologically different types of meningioma: one is round, and the other is the "en-plaque" form, that grows along the dura mater like a sheet. The "en-plaque" form, is unusual. We report on an unusual case of epidural and extraspinal "en-plaque" meningioma, describing the MRI and CT features and discussing the possible principal differential diagnosis (neurolymphomatosis, plexiform neurofibromas/schwannomas and metastasis).

The diagnosis of spinal tumors: established and emerging methods

Spinal tumors comprise a biologically heterogeneous group of neoplasms associated with different treatment strategies and varying prognoses. The accurate diagnosis of these tumors is, therefore, imperative to direct appropriate patient care. Here, the authors review established and emerging tools in the fields of diagnostic imaging and pathology for the assessment of spinal tumors. An approach to standard diagnostic imaging modalities such as plain radiographs, computed tomography, magnetic resonance imaging and angiography is discussed with emphasis on the application of emerging methods such as diffusion tensor imaging, and magnetic resonance spectroscopy to the diagnosis of spinal tumors. Tissue-based diagnostic approaches, including histology and immunohistochemistry, are also reviewed, with a discussion of future trends in the fields of genetics and molecular biology. The authors additionally summarize classical findings of common spinal tumors. With the appropriate clinical suspicion, numerous complementary tools are used to facilitate the diagnosis of spinal tumors. Increasing knowledge of tumor biology and better discrimination of tumor subtypes will continue to play a significant role in guiding patient-specific treatment decisions.

Primary spinal intramedullary primitive neuroectodermal tumor

Though primitive neuroectodermal tumor has been considered to arise from a neoplastic transformation of primitive neuroepithelial cells with propensity to involve any part of the central nervous system, a primary intramedullary spinal primitive neuroectodermal tumor is very unusual. The authors describe a case of an 18-year-old female with conus intramedullary tumor diagnosed to be primary spinal primitive neuroectodermal tumor following histopathological examination after surgery. The diagnosis of such a tumor is very crucial as the management strategies for these are relatively unclear and are associated with a poorer outcome compared to the other common intramedullary spinal tumors.

Minimally invasive lateral extracavitary resection of foraminal neurofibromas

Nerve sheath tumors are the most common spinal tumors but extradural foraminal nerve sheath tumors are much rarer. Traditionally, these nerve sheath tumors have been resected via an open posterior approach. We describe an alternative minimally invasive (MIS) lateral extracavitary approach for resection of symptomatic extradural foraminal spinal neurofibromas. We describe three consecutive male patients (mean age, 37 years) who underwent a successful MIS lateral extracavitary approach for surgical resection of symptomatic extradural spinal neurofibromas. All patients presented with pain and two of the three presented with neurological deficit. Follow-up data, including functional and radiographic outcomes, were collected for all patients. The mean operative time, blood loss, and length of stay were 85 minutes (min) (range, 60–120 min), 150 mL (range, 100–200 mL), and two days (range, 1–3 day), respectively. There were no complications. All patients had complete resolution of their pain and motor deficits. Thus, the MIS lateral extracavitary approach is a safe and feasible alternative for resection of spinal extradural foraminal neurofibromas.

Thymoma metastatic to the extradural spine

Spinal epidural metastases are the most common spinal tumor, occurring in 10% of cancer patients. Malignant thymoma is a mediastinal tumor, with extrathoracic metastases occurring in 15% of patients to liver, kidney, and bone. Spinal metastasis is exceptionally rare. We present a case of thymoma with extradural metastasis and discuss the relevant literature. We describe a 45-year old man presenting with back pain and hypoesthesia twelve years after a diagnosis of thymoma. A review of the literature reveals few cases of thymoma metastatic to the extradural spine. We describe a novel surgical approach allowing ventral spinal cord decompression through a posterior incision. Spinal epidural metastases should be suspected in all cancer patients with back pain. Early detection of epidural metastases may enable improved pain control and preservation of spinal stability, ambulation and sphincter control.

Les tumeurs osseuses rachidiennes chez l'enfant et l'adolescent

The occurrence of back pain in children and adolescents varies from 30 to 51% in the literature. Bone tumors can be responsible for back pain. This paper presents the more common spinal bone tumors in children and adolescents, and specifies their etiology, their natural history, and their treatment as well.

Ossified Thoracic Spinal Meningioma: Report of Two Cases

Spinal meningioma is one of relatively common spinal tumors with an incidence of 25-46%. However, ossified spinal meningioma is known to be extremely rare and its incidence of all the meningiomas is about 0.7-5.5%. Until now, there has been no report of ossified meningioma in Korea. We experienced two cases of this rare lesion, and we report on the CT and MRI findings along with a review of the related literature.

Spinal tumors

Spinal tumors are uncommon lesions but may cause significant morbidity in terms of limb dysfunction. In establishing the differential diagnosis for a spinal lesion, location is the most important feature, but the clinical presentation and the patient’s age and gender are also important. Magnetic resonance (MR) imaging plays a central role in the imaging of spinal tumors, easily allowing tumors to be classified as extradural, intradural–extramedullary or intramedullary, which is very useful in tumor characterization. In the evaluation of lesions of the osseous spine both computed tomography (CT) and MR are important. We describe the most common spinal tumors in detail. In general, extradural lesions are the most common with metastasis being the most frequent. Intradural tumors are rare, and the majority is extramedullary, with meningiomas and nerve sheath tumors being the most frequent. Intramedullary tumors are uncommon spinal tumors. Astrocytomas and ependymomas comprise the majority of the intramedullary tumors. The most important tumors are documented with appropriate high quality CT or MR images and the characteristics of these tumors are also summarized in a comprehensive table. Finally we illustrate the use of the new World Health Organization (WHO) classification of neoplasms affecting the central nervous system.