Extradural Mass Research Articles

Epidural myelolipoma in a Husky-cross: a case report

Epidural spinal myelolipoma was diagnosed in an 11.5-year-old castrated male Husky-cross that was evaluated at the veterinary teaching hospital due to progressive thoracolumbar spinal hyperaesthesia and mild proprioceptive pelvic limb ataxia. A focal, ill-defined mildly inhomogenous extradural mass lesion was detected by MRI. The dog was euthanized. At necropsy an extradurally located reddish mass of about 2.5 cm in diameter was present in the vertebral canal. The mass was identified histopathologically as an epidural myelolipoma.

Lumbar extradural dumbbell cavernous hemangioma: A rare lesion

A 52-year-old female presented with slowly progressive left lower limb polyradiculopathy. MRI of the lumbar region revealed an extradural dumbbell mass at L3 vertebral level, isointense on T1W and hyperintense on T2W images with homogenous contrast enhancement and extending into paraspinal region through left L3/4 foramen. L2 to L 4 left hemilaminectomy and excision of intraspinal part of tumor was performed. Histopathological examination revealed presence of cavernous hemangioma. This case is reported because of its rarity, unusual dumbbell shape of lesion and difficulty in making a preoperative diagnosis without a coexisting bone lesion.

Posteriorly migrated thoracic disc herniation: a case report

IntroductionPosterior epidural migration of thoracic disc herniation is extremely rare but may occur in the same manner as in the lumbar spine.Case presentationA 53-year-old Japanese man experienced sudden onset of incomplete paraplegia after lifting a heavy object. Magnetic resonance imaging revealed a posterior epidural mass compressing the spinal cord at the T9-T10 level. The patient underwent emergency surgery consisting of laminectomy at T9-T10 with right medial facetectomy, removal of the mass lesion, and posterior instrumented fusion. Histological examination of the mass lesion yielded findings consistent with sequestered disc material. His symptoms resolved, and he was able to resume walking without a cane 4 weeks after surgery.ConclusionsPre-operative diagnosis of posterior epidural migration of herniated thoracic disc based on magnetic resonance imaging alone may be overlooked, given the rarity of this pathology. However, this entity should be considered among the differential diagnoses for an enhancing posterior thoracic extradural mass.

Zoonotic Onchocerca lupi Infection in a 22-Month-Old Child in Arizona: First Report in the United States and a Review of the Literature

A 22-month-old girl presented with neck pain and stiffness and magnetic resonance imaging showed an extradural mass extending from C2 through the C4 level with moderate to severe compression of the cord. A left unilateral C2-C4 laminectomy was performed revealing an extradural rubbery tumor; a small biopsy was obtained. Examination of stained tissue revealed the presence of a parasitic worm that was identified as a gravid female Onchocerca lupi. A magnetic resonance imaging at 7 weeks follow-up showed a significantly decreased size of the enhancing lesion and the patient's symptoms gradually resolved. This is the first report of zoonotic O. lupi in the United States. The parasite has been reported in dogs and cats in the western United States, and from people in four cases reported from Europe. A great deal more needs to be learned, including full host range and geographic distribution, before we fully understand O. lupi infections in animals and man.

En-Plaque Spinal Meningioma

Meningioma is one of the most common intradural spinal tumors. Its extradural location accounts for only 2.7% to 10% of all spinal meningiomas and the en-plaque variety is all the more rare with only a few reported cases. A 40-year-old woman presented with a history of pain along the inner border of her right upper limb and tightness in both lower limbs. Examination revealed right grip weakness and hypertonicity of both lower limbs. Magnetic resonance imaging of the spine showed an extradural spinal mass from the C6 to D2 vertebral level exiting through the D1 intervertebral foramina. She underwent grade III excision of the tumor. Histopathologic examination confirmed it to be a meningioma. Postoperatively, the patient had good neurological recovery.

Primary malignant lymphoma of the cranial vault with extra- and intracranial extension.

Bone involvement is a common finding in many types of lymphomas, particularly in advanced stages. However, cranial vault affliction has been regarded as an exceedingly rare presentation. Here, we report the case of a patient with cranial vault lymphoma who presented with a scalp mass. An 81-year-old woman presented with a gradually growing and non-painful frontal scalp mass that she noticed one month before admission. It was a flatly elevated, round mass measuring about 6×4×4 cm. Computed tomography and magnetic resonance imaging of the brain revealed a contrast-enhancing intracranial extradural mass at the counter-location of the scalp mass. The superior sagittal sinus was involved at the tumor site. Cerebral angiography showed that the tumor feeding vessels originated from the bilateral external carotid arteries. An operation was performed and the tumors were removed together with the involved bone. The pathologic diagnosis was malignant diffuse large B-cell type lymphoma. The patient was transferred to the Hemato-Oncology department for chemotherapy. Primary lymphoma of the cranial vault with scalp mass is very rare but it should be considered in the differential diagnosis of scalp masses. Although the results of reported cases are variable, the combination of surgery, radiation, and chemotherapy appears to offer favorable outcomes.

Tophaceous gout of the spine causing neural compression.

Gout is a common metabolic disease in which monosodium urate crystals called tophi develop. Spinal involvement in gout resulting in neural compression is unusual. We describe a case of a 64-year-old man with a history of gouty arthritis of the knee. The patient presented with thoracic myelopathy and radiculopathy. Imaging of the spine revealed an extradural mass lesion with bony erosion of the thoracic spine. A decompressive operation was performed, and a chalky white material was found. Histopathological examination confirmed a gouty tophus. The symptoms of spinal gout vary and its radiological features are not sufficiently specific to provide a definite diagnosis. Therefore, in patients with a history of gouty arthritis who present with neural compressive symptoms of the spine, spinal gout should be strongly suspected.

Lumbar spinal chondroma presenting with acute sciatica.

A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

Isolated Intraspinal Juvenile Xanthogranuloma in an Infant Presenting as Acute Paraplegia

Juvenile xanthogranuloma is a histiocytic proliferative disease that predominantly affects the skin. Extracutaneous involvement is rare. We present the case of a 6-month-old infant with acute paraplegia. Magnetic resonance imaging showed an intraspinal extradural mass at midthoracic level with marked compression of the spinal cord. Complete tumor removal was achieved by emergency surgery and was followed by complete neurologic recovery. Histologic examination led to the diagnosis of a juvenile xanthogranuloma. To the best of our knowledge, an isolated intraspinal juvenile xanthogranuloma in the first 12 months of life has not been described before.

McCune-Albright Syndrome Mimicking Malignancy: an Endocrine Disease From Oncologist’s Perspective

Fibrous dysplasia (FD) is categorized as either monostotic or polyostotic and may occur as a component of McCune-Albright syndrome (MAS). Imaging findings can mimic neoplastic diseases. We present a case of MAS initially suspected to have neoplastic disease. A 9-year-old girl was admitted to pediatric emergency with ataxia. Upon hospitalization, an extradural mass was seen on cranial magnetic resonance imaging (MRI) and the bone survey showed lytic lesions in the long bones. The patient was referred to the pediatric oncology department with a presumptive diagnosis of Langerhans cell histiocytosis or metastatic tumor. Further investigations demonstrated that the patient had MAS and coexisting postinfectious cerebellitis. The findings in this patient demonstrate that the radiographic findings and the clinical presentation of FD and MAS may be similar to those of malignant diseases. Conflict of interest:None declared.

Discal Cyst in Pediatric Patients: Case Report and Review of the Literature

Discal (intraspinal extradural) cysts which communicate with intervertebral disk are uncommon cause of lumbar radiculopathy, especially in pediatric patients. Only three pediatric cases have been reported in the literature. A 15-year-old boy presented with acute onset left-sided S1 radiculopathy. Magnetic resonance imaging of the lumbar spine revealed a well-defined round extradural mass seated in the left ventrolateral epidural space of the spinal canal behind the S1 vertebral body. He did not respond to the conservative therapies. Because of persistent left S1 radiculopathy, left laminotomy was performed at L5-S1 level with coagulation of the posterior longitudinal ligament surrounding the anular tear; however, discectomy was not done. The symptoms resolved and no recurrence was found at 7-year follow-up. The clinical manifestations, imaging findings, possible pathogeneses, and treatment options of these lesions are discussed and the relevant literature is reviewed.

Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour

Spontaneous chronic epidural hematomas are extremely rare and can be extremely challenging to diagnose and differentiate. The clinical findings, computed tomographic scan and magnetic resonance imaging does not always enough to complete differentiate this condition. Our purpose is to report a case of a spontaneous chronic epidural hematoma presenting as an extradural mass leading to compressive radicular symptoms with images of bony scalloping which are sparsely reported in the literature. We describe a 61-year-old woman who was evaluated after 18-month history of pain, disestesias and mild weakness in both lower extremities with significant radicular symptoms on the right side associated to neurogenic claudication. CT scans revealed a nodular image of soft tissue density located in the right anterolateral epidural space at the L4-L5 level demonstrating resorption of the bony margins. MRI studies revealed a round mass in the vertebral canal displacing the dural sac and scalloping the posterior wall of the L4 vertebral body. Diagnosis was established between a degenerative cyst versus an atypical neurinoma. Surgical findings demonstrated an isolated well-formed chronic hematoma. Spontaneous chronic epidural hematomas are rare, even more when they produce scalloping of bony structures becoming a diagnostic challenge. Therefore they should be always considered as a differential diagnosis in patients with extradural chronic compressions taking into account that also chronic epidural hematomas can cause bone involvement.

Solitary Spinal Extradural Plasmacytoma: A Case Report and Literature Review

Solitary spinal extradural plasmacytoma (SSEP) is a rare but distinct form of plasma cell disorder. The clinical picture and treatment of SSEP are reviewed using the seven previously reported cases. The three male and four female patients were aged 40-85 years. The location was cervical spine in one patient, cervicothoracic in one, thoracic in two, thoracolumbar in one, lumbar in one, and extensive involvement in one. Progressive paraparesis and sensory disturbance were the predominant symptoms. Neuroimaging showed a compressive extradural mass lesion in the dorsal spinal canal without findings of local bone destructive changes in all cases. Four of five patients who underwent decompressive surgical maneuver and tumor resection showed neurological improvement. Immunoglobulin (IgG) kappa subtype was the most predominant histological type, followed by IgD lambda and IgA kappa subtypes. SSEP should be included in the differential diagnosis of an extradural tumor located in the dorsal spinal canal without associated bony changes. Surgery may be effective for symptomatic relief.

Primary Ewing’s Sarcoma of the Lumbosacral Spine: A Case Report

Ewing's sarcoma is a rare tumor first discovered by James Ewing in 1921. It is more common in bone or skeletal component compared to soft tissue or extraosseous Ewing's sarcoma. Among soft tissue Ewing’s, spinal cord involvement is rarer with only nine cases reported. We report a case of nine-year-old Malay girl who presented with low back pain for two months following a fall with progressive neurological deficits of bilateral lower limb. Magnetic resonance imaging was suggestive of a well-defined margin of intradural extramedullary tumor. With nerve sheath tumor in mind, surgical excision with laminectomy L2-S1 was performed. Intraoperative finding was an extradural mass from L3-L5 with extension to bilateral neuroforamen. Histopathology report defined a round cell tumour of Ewing’s sarcoma from the mass.

MRI findings of intraspinal extradural paragonimiasis granuloma in a child

Spinal paragonimiasis is a rare entity. We present a unique case of paragonimiasis involving the extradural space. MR imaging of the thoracic spine showed a bean-shaped extradural mass that extended through the left intervertebral foramen to paravertebral thickened pleura. This finding offers imaging evidence to support the theory that larvae of Paragonimus migrate through perivascular or perineural tissues into the extradural space. Another MRI finding was the hemorrhagic foci in the mass, which occurs frequently in the intracranial paragonimiasis and could also be a feature of the intraspinal paragonimiasis granuloma.

Accuracy, intermethod agreement, and inter-reviewer agreement for use of magnetic resonance imaging and myelography in small-breed dogs with naturally occurring first-time intervertebral disk extrusion

To determine accuracy, intermethod agreement, and inter-reviewer agreement for multisequence magnetic resonance imaging (MRI) and 2-view orthogonal myelography in small-breed dogs with first-time intervertebral disk (IVD) extrusion. Prospective evaluation study. 24 dogs with thoracolumbar IVD extrusion. Each dog underwent MRI and myelography. Images obtained with each modality were independently evaluated and assigned standardized scores in a blinded manner by 3 reviewers. Results were compared with surgical findings. Inter-reviewer and intermethod agreements were assessed via κ statistics. Accuracy was assessed as the percentage of dogs for which ≥ 2 of 3 reviewers recorded findings identical to those determined surgically. Inter-reviewer agreement was substantial for site (κ = 0.70) and side of IVD extrusion (κ = 0.62) in T2-weighted magnetic resonance images and was substantial for site (κ = 0.72) and fair for side of extrusion (κ = 0.37) in myelographic images. Agreement for site between each modality and surgical findings was near perfect (κ = 0.94 and 0.88 for MRI and myelography, respectively). Intermethod agreement was substantial for site (κ = 0.71) and moderate for side of extrusion (κ = 0.40). Accuracy of MRI for site and side was 100% when results for T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences were combined. Accuracy of myelography was 90.9% and 54.5% for site and side, respectively. Agreement between imaging results and surgical findings for identification of IVD extrusion sites in small-breed dogs was similar for MRI and myelography. However, MRI appeared to be more accurate than myelography and allowed evaluation of extradural compressive mass composition.

Primary hydatid disease of the occipital bone presenting as space occupying cystic mass of the posterior fossa; case report

Brain involvement of hydatid disease accounts for 1 to 4% of all cases. Extra-Dural, intra-calvarial location is even less. We report, a 24 years old woman with primary intra-calvarial hydatid cyst that presented as an extradural cystic mass lesion of the posterior fossa. In the case presented, removal of the pathology without rupture could not be achieved. As same with the other locations, hydatid cysts of calvaria must be tried to be removed without rupture when possible. However, this exceptional host, the calvaria, seems to ease the pre-mature rupture of the cyst due to the neighboring sharp edges of the bone. In such situations, excessive irrigation with hyper-tonic solutions, %3 NaCl for example, is known to be effective for preventing dissemination. Pre-operative diagnosis is very important for surgical planning. Extra-dural locations of cystic lesions must remind the surgeon hydatid cysts especially in the countries where the disease is more common. J. Exp. Clin. Med., 2012; 29:77-79

MRI appearances of a destructive giant cell tumor and aneurysmal bone cysts of the lumbosacral spine

CASE REPORT We report a case of a 35­year­old man who was hospitalized on January 23, 2008 who complained of experiencing weakness on both legs for six months prior to his hospital admission. The weakness started on his left leg after he played badminton and lasted for three months. Two weeks later, he felt weakness in his right leg. He also felt cramps and pain on his lower back, and it spread down to the lower leg. The pain was aggravated by coughing and sneezing. He could not normally urinate and defecate. There was no history of trauma, fever, chronic cough, diabetes and cardiac disease. Based on neurologic physical examination, movement on the lower limb had decreased. Additionally, pathological reflex at the lower limb, the muscle tone and the physiological reflex decreased as well. Sensory functions were anesthetized from acral until S1 dermatome and hypoesthesia from the S1 dermatome until L3 dermatome in both sides. Routine and blood chemistry analyses revealed the following results: white blood cell 8.43/mm3, red blood cell 4.21x106/mm3, hemoglobin 12.7 g/dL, hematocrit 38%; platelet 310x103/mm3, blood sedimentation rate 1 hr – 11 mm and 2 hr – 30 mm (normal value for males below 10 mm/1st hr glucose (random) 95 mg/dL, total cholesterol 194 mg/dL, HDL 46 mg/dL, LDL 70 mg/dL, triglyceride 146 mg/dL, uric acid 4.6mg/dL, urea 29mg/dL, creatinine 0.73 mg/dL, SGOT 15 mg/dL, SGPT 11 mg/dL, alpha­ fetoprotein 1.59 mg/mL (Normal value <12.5 mg/mL), anti TB IgG ­ negative and prostate­specific antigen (PSA) 2.73 mg/mL (normal value <4 mg/mL). The perspiration test showed no color change from acral up to the knee (spinal cord dermatome L3). An anterior posterior (AP)/lateral view of lumbosacral X­ray showed that alignment of lumbosacral vertebrae was changed; destruction of posterior part of lumbar 4–5 vertebrae corpus and destruction of right lumbar 4 pedicles and bilateral lumbar 5 pedicles; narrowing in the vertebral discus of L4–5; bone mineralization in normal range and soft tissue was normal limit suggesting metastatic tumor to the vertebra corpus. An magnetic resonance imaging (MRI) examination was performed with and without administration of intravenous Gadolinium (Gd­DOTA). The result revealed an extradural mass with mix­intensity (iso, hypo and hyperintense) in sagittal T1­weighted images of the lumbosacral region (Figure 1) and extradural mass with mix­intensity (iso and hyperintense) in sagittal T2­weighted images of the lumbosacral region (Figure 2). Sequential sagittal T2­weighted images Fat­ Sat with MR­myelography revealed a clear border, lobulated side with the solid component of the mass, cyst containing blood (level fluid appearance) in the large areas that were spreading to the anterior and posterior regions and also damaging the surrounding bones, and compressing thecal sac and nerve roots bilaterally, that cause stenosis canalis spinalis at that level (Figure 3). These findings suggested destructive giant­cell tumor and aneurysmal bone cysts in the lumbosacral spine of vertebrae corpus L3–S2 level. The patient was recommended neurosurgical operation. The tumor was biopsied and revealed the histopathology as carcinoma metastases at the vertebrae (it was very CLINICAL IMAGES OPEN ACCESS

Discal cyst of the lumbar spine: a case report.

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

Cervical spinal cord compression as an initial presentation of prostate cancer: a case report

Prostate cancer is notorious for its atypical presentation. However, spread to the cervical spine is uncommon. We herein describe the findings in a 57-year-old African American gentleman, who presented with neck pain and right-sided weakness. Examination revealed neck tenderness with numbness in the distribution of C6 region on right side. An MRI of the neck imaged a 3.4cm extradural soft tissue mass in the C6 region extending into the spinal-canal, causing spinal cord compression. At this point, differential diagnosis included: metastatic cancer vs. chronic granulomatous vs. primary CNS lesion. Management included high dose intravenous steroids and mass resection with cervical-spine fusion. The prostate specific antigen (PSA) was 1815 ng/mL (normal less than 4 ng/mL) with a repeat value of 1666 ng/mL, and the pathology findings confirmed the mass to be metastatic prostate carcinoma. This case illustrates an unusual presentation of metastatic prostate cancer, lytic in nature, presenting as cord compression, and sparing the bone and lymph nodes in the cervical region. Metastatic lesions of prostate cancer to the bone are most often blastic rather than lytic in nature [11]. Cervical involvement is seen in only 5% of cases. Regardless of this atypical presentation, early diagnosis of cord compression is of utmost importance because neurologic status upon presentation has important prognostic value. It is important to consider prostate cancer metastasis in any compressive neuropathy, or findings of an atypical mass affecting the cervical spine.