Differential Diagnosis Of Spinal Tumors Research Articles

Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature

BackgroundSpinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management.Case presentationWe report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient’s sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3–L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted.ConclusionsIntradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.

Paravertebral paraganglioma with spinal extension: a case report

BackgroundParagangliomas are rare neuroendocrine tumors. While paragangliomas of the spine are rare, those located in non-cauda equina areas with spinal canal extension are even rarer.Case presentationWe present a case of a 23-year-old female of African descent with a primary thoracic paraganglioma with intervertebral extension resulting in displacement and compression of the spinal cord and extensive local invasion of the surrounding structures. This paraganglioma was functional with typical symptoms of catecholamine excess. Despite the aggressive nature of the paraganglioma, the patient only had isolated sensory symptoms in the left shoulder. Adequate alpha and beta-blockade were instituted prior to her undergoing surgery with near-total resection and complete preserved neurology. There was no underlying pathogenic genetic mutation found.ConclusionsEven though rare, paraganglioma should be considered in the differential diagnosis of spinal tumors. Genetic testing should be performed in patients with paragangliomas. One should exercise extreme caution in treating such rare tumors that may cause neurological deficits and careful surgical planning should be undertaken to avoid possible catastrophic complications.

Improved Algorithm-Based Magnetic Resonance Images Combined with Computed Tomography in the Diagnosis of Acquired Immune Deficiency Syndrome Combined with Spinal Tuberculosis

This study aimed to analyze the diagnostic value of magnetic resonance imaging (MRI) combined with computed tomography (CT) based on the improved algorithm for acquired immune deficiency syndrome (AIDS) combined with spinal tuberculosis, so as to provide an effective reference theory for the clinical application of imaging diagnosis. The ResNet and Inception network structure were combined to form an improved convolutional neural grid classification (CNGC) algorithm. The improved algorithm was applied to AIDS patients with spinal tuberculosis to evaluate its diagnostic effect and value. 50 patients with AIDS and spinal tuberculosis and 50 patients with spinal tumors were selected for MRI and CT scans. The results showed that the accuracy, specificity, and sensitivity of the improved ResNet-Inception algorithm were much higher than those of the ResNet18 and GoogLeNet algorithms. In addition, compared with the training losses of ResNet18 and GoogLeNet algorithms that converged after 700 times, the ResNet-Inception algorithm only required 350 times to achieve convergence. Based on the improved ResNet-Inception algorithm, the false positive rate (FPR) of AIDS combined with spinal tuberculosis in imaging examinations was about 4%, which was greatly lower than that of the other two traditional algorithms ( P < 0.05 ). It can be seen that the improved ResNet-Inception algorithm was more valuable than traditional algorithms for MRI combined with CT in the diagnosis of AIDS combined with spinal tuberculosis and showed great clinical value for the diagnosis of the disease and the differential diagnosis of spinal tumors.

Histopathological study of primary spinal Cord tumors

Primary spinal cord tumors account for 10-15% of all primary Central Nervous System tumors. Spinal cord tumors can be classified according to their anatomical locations. Lesions outside the dura are termed extradural and lesions within dura are called intradural. Intradural are further classified into two categories, whether they involve substance of the spinal cord (intramedullary) or are outside the spinal cord but within the dura (extramedullary). Ependymomas are the most common glial tumor in adults, whereas astrocytomas are the most common intramedullary tumor in children. This study was undertaken from June, 2017 to June, 2019 and the total cases encountered were 91 with males constituting 40 cases (44%) and females constituting 51 cases (56%). Most common symptom was motor weakness followed by pain, sensory loss and bladder dysfunction. The tumors includes Meningiomas 29 Cases (32%), Ependymoma 24 cases(26%), Neurofibromas 17 cases(19%), Schwannomas 09 cases(10%), Astrocytoma 06 cases(7%) and others. All differential diagnosis of spinal tumors are kept in mind as correct diagnosis helps in the treatment and prognosis.

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.

Spinal tumors: Trends from Northern India.

Introduction and Methods:We retrospectively analyzed 111 patients with spinal tumors operated over a period of 9 years to observe the relative frequency of different lesions, their clinical profile, functional outcome and prognostic factors. 30/111 (27%) were extradural, 40/111 (36.1%) were intradural extramedullary (IDEM) and 41/111 (36.9%) were intramedullary spinal cord tumors (IMSCTs). Mean age at surgery was 30.81 years (range 1–73 years). The average preoperative duration of symptoms was 16.17 months (15 days to 15 years). Major diagnoses were ependymomas and astrocytomas in IMSCT group, schwanommas and neurofibromas in IDEM group, and metastasis, lymphoma in extradural group. The common clinical features were motor weakness in 78/111 (70.27%), sensory loss in 55/111 (49.54%), pain 46/111 (41.44%), and sphincter involvement in 47/111 (42.43%) cases.Results:Totally, 88/111 (79.27%) patients had improvement in their functional status, 17/111 (15.31%) remained same, and 6/111 (5.4%) were worse at time of their last follow-up. The mean follow-up was 15.64 months (1.5 m−10 years). Totally, 59 out of 79 patients, who were dependent initially, were ambulatory with or without the aid. Most common complication was persistent pain in 10/111 (9%) patients and nonimprovement of bladder/bowel symptoms in 7/111 (6.3%). One patient died 3 months after surgery.Conclusions:(1) Congenital malformative tumors like epidermoids/dermoids (unrelated to spina bifida) occur more frequently, whereas the incidence of spinal meningioma is less in developing countries than western populations. (2) The incidence of intramedullary tumors approaches to that of IDEM tumors. Intramedullary tumors present at a younger age in developing countries. (3) Rare histological variants like primitive neuroectodermal tumors should also be considered for histological differential diagnosis of spinal tumors. (4) Preoperative neurologic status is the most important factor related to outcome in spinal tumors.

Primary paraganglioma of the spine: A clinicopathological study of eight cases.

Context:Spinal paragangliomas are rare neuroendocrine tumors of the extra-adrenal paraganglionic system.Aims:This study describes the clinicopathological features of eight cases of spinal paraganglioma and highlights the significance of important morphological features and immunohistochemistry in the diagnosis of paraganglioma at this unusual site.Material and Methods:All the cases of primary spinal paragangliomas diagnosed during the last six years (2008-2013) in the Department of Pathology at our hospital were reviewed.Results:There were six males and two females. The mean age at diagnosis was 50.4 years. All patients presented with low back pain. All tumors were located in the cauda equina or conus medullaris region. Magnetic Resonance Imaging and intraoperative appearance were that of a vascular, well-circumscribed intradural, extramedullary tumor suggestive of either schwannoma or ependymoma. All the patients underwent gross total resection of the tumor. Histopathology in five of the cases showed ‘ependymoma-like histology’ while only three cases had a predominant classic ‘zellballen’ pattern. Two cases had prominent ‘gangliocytic differentiation’. In the five cases with ‘ependymoma-like histology’, the diagnosis was confirmed on Immunohistochemistry (IHC).Conclusions:Even though relatively rare, paraganglioma should be considered in the differential diagnosis of spinal tumors and due to their clinical, radiological and histopathological similarity to schwannoma and ependymoma, the diagnosis should be based on close examination of the clinical, radiological and pathological findings.

Primary clear cell chondrosarcoma of the spine: a case report of a rare entity and a review of the literature.

Chondrosarcoma is the third most common primary malignant bone tumor after osteosarcoma and Ewing's sarcoma. Clear cell chondrosarcoma is a rare subtype variant of chondrosarcoma, most commonly encountered in the proximal part of the femur or humerus. Vertebral involvement is exceedingly rare and shows a predilection for the thoracic spine. We report the case of a woman with clear cell chondrosarcoma of the thoracic spine, which has been surgically excised, and review the pertinent literature (PubMed). Although it has a reasonably benign biological behavior, clear cell chondrosarcoma needs to be treated as a malignancy. The best treatment for spinal chondrosarcoma is surgery. It should be promptly and adequately resected. Gross-total resection should be the ultimate surgical goal. Radiation therapy should also be considered, especially in the case of subtotal resection or inoperable lesions. In conclusion, it is important to keep in mind this entity in the differential diagnosis of spinal tumors, in order to optimize treatment planning. With adequate treatment, local recurrence rates as low as 20% can be achieved.

Chordoma of the thoracic spine in an 89-year-old

Case report and literature review. Report the highly unusual presentation of thoracic spine chordoma in an 89-year-old and review existing literature as it impacts treatment in the elderly. Chordomas are infrequent tumors of the spine that commonly present during mid-adulthood at the spheno-occipital or sacrococcygeal junctions. The mobile spine is affected in 10-15% of cases but chordomas are extremely rare in the thoracic spine. Chordoma rarely enters the differential diagnosis of spinal tumors in elderly patients, for whom metastases and multiple myeloma are by far the most common. A case report is detailed of an 89-year-old male presenting with incapacitating pain and early signs of thoracic myelopathy. A lytic, expanding lesion of the T10 vertebral body with epidural spinal cord compression was identified. In the absence of evidence of other primary tumor, a CT-guided needle biopsy revealed chordoma. A literature review of reported thoracic spine chordomas was also performed. An intralesional posterolateral resection and reconstruction was performed with good results and no recurrence at 13 months' follow-up. 30 reports of thoracic spine chordomas were identified in the literature since 1902. Mean age of presentation at 35.7 years is earlier than for most chordomas. The oldest previously reported patient was 68-year-old. Neurological impairment at presentation is rare with the usual presenting symptom being pain. Response to radiation and chemotherapy is limited. 5-year survival rates range from 50 to 60%. Chordoma is a highly uncommon epidural neoplasm of the thoracic spine and is vanishingly rare in elderly patients. This report documents the oldest reported patient with thoracic spine chordoma at 89-year-old. Their locally aggressive behavior typically prompts consideration of aggressive surgical resection. When tailored to the individual patient, such procedures are feasible without excessive morbidity even in elderly patients.

Malignant triton tumors of the spine

Malignant triton tumors (MTTs) are malignant peripheral nerve sheath tumors with rhabdomyosarcomatous differentiation. Malignant triton tumors affecting the spine are rare but present special challenges to the neurosurgeon. The authors report on 2 new cases of spinal MTTs, and analyze the 8 previously reported cases found via database search. The patients include a 15-year-old girl with thoracic MTT, and a 24-year-old man with lumbosacral MTT; both patients underwent radical resection with spinal stabilization. When these cases were combined with the literature results there was a male/female ratio of 6:4, and an age range of 15-67 years (median 37.5). Nine patients presented with symptoms related to the spinal cord, cauda equina, or nerve root compression. Four patients had undergone previous radiotherapy, and 2 had neurofibromatosis Type 1. Five cases of MTT were lumbosacral, 4 were thoracic, and 1 was cervical. Seven patients had intradural extension of tumor. All patients underwent some form of surgery, with 8 having total macroscopic excision. However, 6 patients required subsequent operations. In the 8 patients for which survival data was available, median time from diagnosis to death was 12 months (range 3-16). Malignant triton tumors are rare but should be included in the differential diagnosis of spinal tumors, particularly in patients who have undergone previous radiotherapy or who have neurofibromatosis. The authors suggest roles for radical surgery and multidisciplinary management.

Primary liposarcoma of the thoracic spine: case report

Liposarcoma is a malignant tumor of soft tissue. The thoracic spine is an unusual location, even for metastasis, and to our knowledge, no case of primary pleomorphic liposarcoma of the vertebral body has been reported until now. A female patient presented with paraplegia. She had a previous medical history of mental depression, and complained of dorsal pain for three months following a road accident. Magnetic Resonance Imaging (MRI) revealed a collapse of T7-T8, and the diagnosis of plasmocytoma was made. She was treated with decompressive laminectomy and posterior instrumentation. Histological examination revealed a pleomorphic liposarcoma. She received a course of radiotherapy. At 13 months follow-up she developed pulmonary metastases and rib involvement. The spine is an unusual location for pleomorphic liposarcoma, even as metastasis. The differential diagnoses of this rare entity are discussed, as well as the criteria for diagnosing primary spinal liposarcoma. Although rare, our case demonstrates that liposarcoma should be considered in the differential diagnosis of spinal tumors.

Intradural schwannomas of the spine: MR findings with emphasis on contrast-enhancement characteristics.

Intradural extramedullary schwannomas are nerve sheath neoplasms that consist of focal proliferations of Schwann cells involving a spinal nerve. We reviewed the MR findings in seven patients with pathologically proved intradural schwannomas. The contrast-enhancement characteristics on MR images were determined and compared with the histologic features of the tumor. Six lesions were variably hyperintense on T2-weighted images and one was uniformly hypointense compared with the signal intensity of the spinal cord. Signal on T1-weighted images ranged from hypointense to isointense. All seven tumors showed heterogeneous enhancement; in five, the enhancement involved only the periphery of the lesion. The pattern of enhancement did not correlate with the signal characteristics noted on unenhanced T1- and T2-weighted images. Pathologically, hyaline thickening of vessel walls and cyst formation were prevalent in the peripherally enhancing lesions. However, enhancement did not correlate with the relative proportion of Antoni type A and type B tissue. Recognition of the MR characteristics of intradural extramedullary schwannomas may be helpful in the differential diagnosis of spinal tumors. In particular, peripheral contrast enhancement of an intradural extramedullary tumor on MR images should suggest the diagnosis of schwannoma.