Differential Diagnosis Of Intramedullary Lesions Research Articles

Intramedullary schwannoma at the thoracic level in a geriatric patient: a case report

Intramedullary schwannoma, a disease that primarily occurs in middle-aged individuals, is a very rare tumor that occurs inside the spinal cord, constituting only 0.3% of spinal cord tumors. These tumors have most often been reported to involve a single lesion in the spinal cord. A magnetic resonance imaging (MRI) examination and histopathological report can confirm the diagnosis of intramedullary schwannoma. We describe a case of intramedullary schwannoma in a 71-year-old female patient. The tumor was evaluated using MRI and through a pathophysiological assessment. The lesion showed diffuse bulbous thickening with an ill-defined central signal change of the spinal cord from C6 to T6 on T2-weighted MRI. During surgery, a reddish and adhesive mass was removed. After the operation, the patient's leg weakness improved. Despite the rarity of the disease, we should consider intramedullary schwannoma as a possible tumor in the differential diagnosis of intramedullary lesions in elderly patients, for which surgical treatment should be considered.

Intradural Intramedullary Teratoma Presenting in the Lumbar Spine: Report of a Rare Case

Intradural teratomas are an exceedingly unusual phenomenon. They are tumors with the cellular constituent source of all the 3 germ cell layers. We here report a case of an 18-year-old man with special pathologic features. There was no history of spinal dysraphism, congenital spinal abnormalities, previous spinal surgery, or lumbar puncture. Lumbosacral spine magnetic resonance imaging revealed a well-delineated, intramedullary mass at the L2-3 level. Histopathology examination of the resected tumor revealed cystic spaces lined with simple columnar epithelium as well as mucus secreting epithelium, adipose tissue, salivary gland-like serous cells, and bundles of smooth muscle cells. We have seen unusual histopathologic features in the case, for example, there were no cartilage components that are mostly found in mature teratomas, abundant Pacinian corpuscle nerve endings, and nerve trunks. There were no immature elements or malignant cells. Teratomas should be taken into consideration in the differential diagnosis of intramedullary lesions, even after the imaging reveals tissue homogeneity.

Exophytic intramedullary meningioma of the cervical spinal cord

Intramedullary spinal cord neoplasms are relatively uncommon. The most common intramedullary tumors are astrocytomas and ependymomas. Meningiomas can occur as an intradural tumor; however, they are typically in the extramedullary compartment. A 42-year-old male presented with progressive sensory loss in the upper extremities and lower extremity weakness. Pre-operative imaging suggested an intramedullary cervical lesion. To treat the progressive neurological abnormality, surgical resection was planned. At surgery, it was noted that the tumor originated in the cervical spinal cord and extended into the extramedullary region. Histology confirmed the lesion to be a meningioma. This meningioma variant has not previously been described. Spinal meningiomas may occur in locations other than intradural, extramedullary locations, and should be included in the differential diagnosis of intramedullary lesions. Intramedullary meningiomas can be successfully treated with surgery.

Unusual presentation of an adult intramedullary spinal teratoma with diplomyelia

Background Spinal teratomas are rare lesions. The authors present an intramedullary spinal teratoma associated with diplomyelia. Case Description This 34-year-old female patient presented with right lower extremity weakness, left lower extremity sensory deficit, and urinary retention. Magnetic resonance imaging showed a focally expansile, intramedullary lesion at L1-2 levels with exophytic component, which was located at the apex of diplomyelia separating the cord into equal hemicords and low-lying spinal cord ending at L3 level. Intraoperative electrophysiologic monitoring was used. Tumor was composed of both intramedullary solid/cystic parts and exophytic fatty infiltrated tissue. There was diplomyelia located caudal to intramedullary lesion and harboring an exophytic lobule at the junction of the nondiplomyelic and the diplomyelic cord. A complete removal was not accomplished because of presence of functional neural tissue within the exophytic component of the lesion. Histopathological examination revealed a mature teratoma. This is the fourth intramedullary teratoma associated with SCM to be reported in the literature. Conclusions Teratomas should be taken into consideration in differential diagnosis of intramedullary lesions associated with SCM. Neuroimaging is helpful, but definitive diagnosis is done by histopathological examination. Radical resection should be the aim; however, excision should be tailored according to intraoperative electrophysiologic monitoring. A truly intramedullary teratoma and an exophytic midline fatty infiltrated tissue bisecting spinal cord is another unique feature of the present case that supports the dysembryogenic origin of spinal teratomas.