Paraspinal Mass Research Articles

Synchronous occurrence of metastatic Wilms tumor and ganglioneuroma

We describe a 4-year-old female patient with a persistent paraspinal mass following chemotherapy for Wilms tumor. A discordant response to chemotherapy prompted biopsy of the persistent mass, which revealed a ganglioneuroma. This report highlights the synchronous occurrence of different tumors in the same patient, and suggests that repeat biopsies should be considered when contiguous tumor masses do not respond as expected.

Intraspinal primitive neuroectodermal tumor: Imaging findings in six cases

Purpose To retrospectively review CT and MRI findings in a series of six intraspinal primitive neuroectoderal tumors and to find out their radiological features. Methods CT and MRI of six patients with surgically and pathologically proved intraspinal primitive neuroectoderal tumor were retrospectively reviewed. The tumor location, morphological features, signal intensity, calcification, contrast enhancement characteristics, involvement of paraspinal soft tissues and adjacent bony structures were assessed. Results Of six patients, four had extradural lesions and two had intradural, extramedullary lesions. Most lesions were well defined and manifested heterogeneous iso- or hypo-intense signal on T1-weighted imaging and hyper-intense signal on T2-weighted imaging and moderate attenuation on CT, and were heterogeneously enhanced after contrast enhancement. The lesion extending through the intervertebral foramen with a large paraspinal soft tissue mass formed was found in four patients and vertebral bone involvement was seen in four patients. Conclusions Although imaging findings are not specific of intraspinal primitive neuroectoderal tumor, this diagnosis could be suggested when MR imaging depicts an intradural, extramedullary or extradural large well-circumscribed mass which extends out from intervertebral foramen and invades paraspinal soft tissues or vertebral bones in a young patient.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

Horner Syndrome Associated With Contusion of the Longus Colli Muscle Simulating a Tumor

A 22-year-old man who was discovered unarousable after an accidental methadone overdose complained of worsening neck pain and left arm weakness over the next week. Examination disclosed a left Horner syndrome and a left brachial plexopathy. Imaging showed a left paraspinal mass adjacent to the sympathetic pathway at the fourth and fifth cervical vertebral levels with imaging features of a tumor. Biopsy was deferred. One month later, the imaging abnormality had nearly disappeared. In retrospect, it represented a contusion injury of the longus colli muscle, a finding not reported previously. Whether it caused the Horner syndrome or was merely a bystander in cervical neck trauma is uncertain. This abnormality should be recognized as a diagnostic confounder.

Lower Lumbosacral Cutaneous Lesion in a Newborn

A term newborn has a cutaneous lesion in the lower lumbosacral region. ### Prenatal History ### Birth History ### Physical Examination ### Imaging ### Cutaneous lesion in lower lumbosacral region ### Occult Spinal Dysraphism On postnatal day 2, magnetic resonance imaging (MRI) of the spine was performed, but results were limited due to motion artifact. A tethered cord was suspected. Repeat MRI on postnatal day 4 confirmed a tethered cord that progressed into a terminal lipoma. An associated sacrococcygeal deformity also was noted. Know the indications …

Intramuscular Myxoma of the Paraspinal Musculature

Intramuscular myxomas are uncommon, benign tumors of mesenchymal origin most noted for their occurrence in the left atrium. We present a rare case of intramuscular myxoma involving the paraspinal muscles of an 80-year-old woman, presenting with longstanding lower back pain. There was no focal neurological deficit. Imaging revealed a large lobulated paraspinal mass, with heterogeneous rim enhancement, causing adjacent bony changes and intraspinal extension. Open spinal biopsy with debridement and drainage of a suspected paraspinal abscess was done. The diagnosis of an intramuscular myxoma was however confirmed on histopathology. Intramuscular myxomas, particularly those occurring in distinctly uncommon locations, with aggressive features, can pose diagnostic challenges and should be included in the differential diagnosis of all paraspinal cystic lesions. J Med Cases. 2010;1(2):42-46 doi: https://doi.org/10.4021/jmc37w

Ancient schwannoma of lumbar spine and review of the literature on paraspinal tumors, the role of preoperative biopsy: a case report

IntroductionSchwannomas are rare encapsulated tumors that derive from the nerve sheath and should be removed due to their infrequent, but existent possibility of malignancy.Case presentationWe report a case of a mass located in the L5 lumbar spine in a 42 year old man, presented with intermittent lumbar pain. Ultrasound, CT and MRI were used to examine the characteristics of the lesion. Fine needle aspiration showed cytologic characteristics of benign schwannoma and final histological diagnosis was ancient schwannoma. An extraperitoneal approach, through a left paramedian incision was used to approach the site of the mass. The lesion originated from the nerve root of the L4-L5 lumbar spinal space and a complete excision was achieved.ConclusionA great variety of tumors should be differentiated when a paraspinal mass is discovered, including neurogenic, neuroendocrine and vascular tumors, as well as malignancies, cystic and inflammatory masses. Fine needle aspiration is a useful and reliable tool in the preoperative evaluation of paraspinal masses. A review of the literature is also presented.

Synovial sarcoma of the thoracic spine

Background context Synovial sarcoma is an uncommon malignant neoplasm occurring chiefly in young adults. It often presents as a solid well-circumscribed soft-tissue mass in the extremities of young adults. Despite its proximity to joints, it has been well established that the tumor cells do not display features of synovial differentiation but instead appear to have a primitive epithelial phenotype. There is no report of a lower thoracic paravertebral synovial sarcoma in an adult male. Purpose To describe our management in a patient with a synovial sarcoma of the thoracic spine and to review previously published cases. Study design Case report. Methods A 60-year-old man presented with a 5-month history of right upper quadrant abdominal pain radiating to his back in a band-like fashion; shortness of breath on exertion; and increasing pain when standing, sitting, or walking. Magnetic resonance imaging (MRI) demonstrated a large right-sided paraspinal mass sitting on the eighth and ninth ribs, pressing on the T9 vertebrae and abutting the T7 and T8 vertebral level exhibiting “Triple Intensity.” Plain films demonstrated a right-sided paraspinal mass extending from the T7–T8 level to T10. Bone scintigraphy showed increased uptake on the right thoracic spine at T7–T8 to T10. Computed tomography (CT) imaging revealed a right paraspinal mass with lytic changes in the T9 vertebral bodies. A right-sided thoracotomy was performed, and the patient underwent subsequent radiation therapy. Absence of the tumor was shown by an MRI scan after the operation. Results Complete resolution of the patient's complaints was achieved. The diagnosis is supported by plain radiographs, bone scintigraphy, magnetic resonance and CT imaging studies, and histologic and immunohistochemical evidence. Conclusions Synovial sarcomas are rarely present in the paravertebral region of the thoracic spine. A careful radiographic study of the tumor permitted early preliminary diagnosis, confirmed upon histopathologic analysis. Despite lytic changes, removal of a periosteal layer permitted sparing of the vertebral bodies.

Textiloma: An uncommon complication of posterior lumbar surgery

A surgical sponge or cotton swab that is inadvertently left behind in a surgical wound eventually becomes a "textiloma". Such foreign material (also called "gossypiboma") can cause a foreign-body reaction in the surrounding tissue. Textiloma is mostly asymptomatic in chronic cases, but can be confused with other soft-tissue masses. Therefore, it is important to be aware of patients who present with a paraspinal soft-tissue mass and unusual or atypical symptoms. Imaging is helpful for arriving at the correct diagnosis. Here, we describe a case of textiloma in which the patient presented with low-back pain 6 years after laminectomy and lumbar discectomy. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the posterior paravertebral region.

Angiofollicular lymph node hyperplasia resembling a spinal nerve sheath tumor: a rare case of Castleman's disease

Background context Angiofollicular lymph node hyperplasia (Castleman's disease) is a lymphoproliferative disorder of unknown etiology. Although uncommon, the localized form of this disease can manifest in the central nervous system, typically as a meningeal-based intracranial lesion. Castleman's disease involving the spine is exceedingly rare. This represents only the second reported case of a patient with Castleman's disease whose presentation mimicked that of a spinal nerve sheath tumor. Purpose We report a rare case of angiofollicular lymph node hyperplasia that mimicked a spinal nerve sheath tumor and was treated with gross total resection. Study design Case report. Patient sample A 31-year-old female with angiofollicular lymph node hyperplasia presenting with a paraspinal mass. Outcome measures The patient's outcome was based on clinical history, physical and radiographic examinations. Methods A 31-year-old woman with a mediastinal mass previously diagnosed as sarcoid via biopsy presented with the new onset of radicular pain and radiographic enlargement of her mass. Magnetic resonance imaging demonstrated a 4.3×5.7×6.0 cm homogenously enhancing soft-tissue lesion that emanated from and widened the T3/T4 neural foramen on the left. The differential diagnosis based on the location of the lesion and imaging characteristics included schwannoma, neurofibroma, paraganglioma, sarcoid, and lymphoma. Gross total resection was performed via thoracotomy. Histological examination identified angiofollicular lymph node hyperplasia (Castleman's disease) of the hyaline-vascular subtype. The patient did not receive adjuvant chemotherapy or radiation therapy. Results The patient had resolution of her symptoms without any clinical or radiographic evidence of recurrence at 1-year follow-up using magnetic resonance imaging with and without contrast. Conclusions Castleman's disease is a rare pathologic entity that should be considered in the differential diagnosis of a patient with a paraspinal mass. Spine surgeons should be aware of this diagnosis as it has treatment and follow-up implications that differ from the neoplasms it can mimic. Complete surgical excision is an effective treatment for solitary lesions. Screening for concurrent and future malignancies in these patients is prudent.

The Usefulness of CT Perfusion in Differentiation between Neoplastic and Tuberculous Disease of the Spine

Routine diagnostic techniques are not sufficient to confidently differentiate diseases of the axial skeleton. Purpose of study was to determine whether CT perfusion (CTP) can differentiate inflammatory diseases like tuberculosis from neoplastic diseases of spine. Fifty-one patients with vertebrdraft%freshal body lesions associated with paraspinal mass underwent CT guided bone biopsy and histopathological evaluation. CTP was done before doing bone biopsy. Perfusion parameters like blood volume (BV), blood flow (BF), and time to peak (TTP) were calculated. Values are correlated with histopathological report of bone biopsy. Statistical analysis was done using Mann-Whitney test. P value < .05 was considered significant. Of 51, 32 had infective osteomyelitis and 19 neoplastic disease (9 metastasis, 5 plasmacytoma, 4 lymphoma and 1 chordoma. Mean rBF was [inflammatory lesions, 1.79 and neoplastic lesions, 9.42 (P < .000)]. Mean rBV was [inflammatory disease, 1.63 and neoplastic lesions, 9.37 (P < .000)]. CTP technique has potential for differentiating inflammatory from neoplastic lesions affecting spine associated with paraspinal mass noninvasively.

Mesenchymal Cystic Hamartoma of the Lung

We report the magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) findings of a patient who presented with lower thoracic pain, nausea, and vomiting and had a CT scan of the chest in which a well-defined homogeneous mass was identified. Further evaluation with MRI and PET/CT showed a nonenhancing homogeneous paraspinal mass in the left lung base involving the left hemidiaphragm. The mass showed lack of enhancement on MRI and was photopenic on PET/CT. Video-assisted thoracoscopic surgery and resection of the mass was performed and showed a mesenchymal cystic hamartoma invading the left hemidiaphragm. Such a growing hamartoma with pleural and diaphragmatic invasion is very atypical and to our knowledge, has not been previously reported.

Retained surgical sponge in differential diagnosis of paraspinal soft-tissue mass after posterior spinal surgery: Report of eight cases

In the postoperative period of posterior spinal surgery, surgeons usually encounter a wide spectrum of complications, including retained surgical sponge, gossypiboma. Retrospective review of case records of eight patients diagnosed with gossypiboma with emphasis on computed tomography (CT) and magnetic resonance imaging (MRI) findings. All the eight patients presented with low back pain and/or symptoms of infection, such as draining from the incision site, fever, and tenderness. The diagnosis was confirmed by the imaging findings on MRI with gadolinium enhancement. Retained paravertebral surgical sponges are seldom reported due to medicolegal implications. Awareness of this complication among neurosurgeons and radiologists is essential to avoid unnecessary morbidity.

Lumbar Actinomycosis: A Case Report

Spinal actinomycosis is a rare infection that usually develops from contagious spreading of the causative organism. Diagnosing this malady may be delayed due to the nonspecific radiological findings and the slow progression of the disease. We present here the case of a 51-year-old male with slowly progressing lower back pain and fever. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a paraspinal mass and cortical destructive change in the L1 vertebra, but the disk space was spared. A surgical biopsy confirmed spinal actinomycosis. We describe the CT and MR imaging findings of this patient and we also review the related literature to highlight this uncommon disease entity.

Thoracic vertebral osteomyelitis secondary to chronic esophageal perforation

Background Context Osteomyelitis secondary to perforation of the esophagus is a rare condition. Thoracic osteomyelitis after chronic esophageal perforation has never been described in the literature. Purpose We report a case of vertebral osteomyelitis resulting from a chronic esophageal perforation. Study Design/Setting Case report/University hospital. Methods A 52-year-old woman presented with dysphagia, severe mid back, and epigastric pain over a 6-week period. Endoscopic and radiological investigations revealed the presence of a paraspinal inflammatory mass protruding into the posterior esophageal wall. Two weeks after admission, the patient developed septic complications which required surgical intervention. This revealed the presence of an esophageal perforation and osteomyelitis of the T4–T5 and T7–T8 vertebrae. After T-tube closure of the esophageal perforation along with surgical debridement of the vertebrae and a 6-week course of antibiotics, the patient made a sound recovery. However, there was persistence of back pain with exaggerated thoracic spine kyphosis at T7–T8 which needed thoracic spine stabilization with pedicle screw instrumentation and fusion. Results This treatment led to complete recovery with no recurrence of symptoms at 8-months' follow-up. Conclusions To date this is the first case of thoracic osteomyelitis secondary to a chronic esophageal perforation to be reported in the literature. A high index of suspicion of this diagnosis is warranted in patients who present with similar clinical and radiological findings to enable prompt diagnosis and avoid the high mortality of esophageal perforation.

Malignant Mediastinal Extra-Adrenal Paraganglioma with Spinal Cord Invasion in a Dog

A 1.5-year-old castrated, male, mixed-breed dog was evaluated because of a 2-week history of lethargy, stiffness, and progressive paraparesis. Spinal radiographs, myelography, and computed tomography of the region showed a locally invasive mass involving the thoracic wall. Upon necropsy, an encapsulated, fluctuant mass was noted attached to the right dorsal body wall in the region of the fifth to seventh thoracic vertebra. Churukian-Schenk staining revealed positive granules within the neoplastic cell cytoplasm and immunohistochemistry was positive for expression for cytoplasmic neuron-specific enolase and synaptophysin. Chromogranin A and S100 expression were found to be negative. Immunohistochemistry and silver staining did not allow further differentiation of the tumor, and the diagnosis remains consistent with either a chromaffin paraganglioma or a nonchromaffin paraganglioma (chemodectoma) with some production of catecholamines. Extra-adrenal paragangliomas are rare neoplasms in dogs but should be considered as a possible differential diagnosis for a primary paraspinal thoracic mass.

Lumbar puncture and surgical intervention in a child with undiagnosed fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) is a rare, autosomal dominant disorder characterized by congenital malformation of the great toes and episodes of soft tissue swelling that lead to progressive heterotopic ossification. The genetic cause of FOP was recently discovered to be a recurrent missense activating mutation in the activin A type I receptor, a bone morphogenetic protein type I receptor in all classically affected individuals worldwide. The authors present a child with the classic features of previously undiagnosed FOP who developed a paraspinal soft-tissue mass after a lumbar puncture for a fever workup. Excision of the mass resulted in a massive inflammatory response leading to progression of heterotopic ossification. Awareness of the classic clinical features of FOP prior to the appearance of heterotopic ossification can prompt early clinical diagnosis and confirmation through genetic testing, thus avoiding interventions that lead to irreversible iatrogenic harm.

Laparoscopic Resection of a Lower Posterior Mediastinal Tumor: Feasibility of Using a Transdiaphragmatic Approach

Either video-assisted thoracoscopic surgery (VATS) or a thoracotomy is usually performed for a resection of posterior mediastinal tumors. We used a laparoscopic approach to resect a lower posterior mediastinal tumor mimicking a right adrenal tumor that had been identified by a preoperative computed tomography (CT) scan, because this approach is less invasive than VATS or a thoracotomy, regarding the potential to cause damage to the respiratory organs. A preoperative CT scan showed a paraspinal mass measuring 5.5 cm in diameter at the level of the 11th thoracic vertebra and gallbladder stones. A laparoscopic transdiaphragmatic excision of this lower posterior mediastinal tumor was attempted and accomplished safely. First, we used the usual laparoscopic transperitoneal approach. Thereafter, we accessed the lower posterior mediastinum by splitting the crural fibers of the diaphragm. The tumor was completely resected without damaging the pleura. We also simultaneously performed a laparoscopic cholecystectomy for gallbladder stones. The operating time was 229 minutes (mediastinal tumorectomy 164 minutes, cholecystectomy 65 minutes) and the bleeding volume was 100 mL. The postoperative course was uneventful. The pathological findings of the specimen demonstrated schwannoma. We found the laparoscopic approach to the lower posterior mediastinum by splitting the diaphragm to be a feasible and less invasive method than either VATS or a thoracotomy. This surgical modality can thus be performed on selected lower posterior mediastinal tumors.

Extramedullary Hematopoiesis on F-18 FDG PET/CT in a Patient With Metastatic Colon Carcinoma

A 43-year-old Kuwaiti man with a history of β-thalassemia intermedia was diagnosed with lymph node-positive sigmoid adenocarcinoma and underwent left hemicolectomy. He had multiple paraspinal masses and a right middle lobe lung nodule on CT scan. F-18 FDG PET/CT imaging revealed intense metabolic activity within the pulmonary nodule and subsequent biopsy revealed metastatic adenocarcinoma. The PET/CT scan also revealed mild to moderate FDG activity in multiple paraspinal thoracic masses. MRI findings were most consistent with multiple sites of extramedullary hematopoiesis.

Neurofibromatosis type 2 and auditory brainstem implantation

Neurofibromatosis type 2 and auditory brainstem implantation