Intramedullary spinal cord metastasis associated with hemorrhage: a case report

A rare case of intramedullary spinal cord metastasis associated with hemorrhage was reported. A 74-year-old man had a subacute onset of paraparesis. He became almost paraplegic within a few days. MRI revealed an intramedullary spinal lesion in the epiconus at the Th 11 and Th 12 level, but spinal angiography did not show any abnormality. Since repeated MRI showed enlargement of the lesion, surgery was performed under the diagnosis of an intramedullary spinal cord tumor. Under general anesthesia, a midline myelotomy of about 3 cm was performed and a grayish, elastic and circumscribed tumor as well as a liquefied hematoma in the caudal part was observed. Both the tumor and the hematoma were removed almost totally. The patient's paraparesis improved slightly after surgery. The histological diagnosis was adenocarcinoma. The primary source was unknown, but multiple small metastatic tumors were found in the lung, liver and brain, etc. Hemorrhage from intramedullary spinal cord metastasis is extremely rare with only 6 reported cases in the recent literature. Rapid deterioration of symptoms caused by the hematoma may make the diagnosis more difficult. Indication of surgical treatment should be carefully determined because prognosis of intramedullary spinal cord metastasis is generally very poor.     

Intramedullary spinal cord metastasis

Intramedullary spinal cord metastases are rarely the presenting manifestation of a previously undiagnosed neoplasms. We report such a case in which a subacutely progressive motor and sensory spinal cord syndrome was the initial problem. The differential diagnosis and the difficulties in distinguishing intramedullary from extramedullary mass lesions are discussed. The special features of tumors of the lung and their predilection for metastasis to the central nervous system are considered.     

Intramedullary spinal cord astrolipoma: case report

OBJECTIVE AND IMPORTANCE: Reported is a case of a thoracic intramedullary astrocytoma with a lipomatous component, a so-called astrolipoma. This is the only known case of a single intraspinal astrolipoma in an otherwise healthy patient. CLINICAL PRESENTATION: The patient was a 36-year-old woman with dorsal thoracic pain of more than 1 month's duration, mild lower extremity weakness, and incomplete sensory loss to the T10 level. INTERVENTION: Magnetic resonance imaging of the thoracolumbar spine revealed a fusiform mass at the T9-T11 level. The patient underwent T9-T11 laminectomies and complete resection of the tumor. In the initial postoperative period, the patient's symptoms worsened. However, 3 months after surgery, the patient was clinically improved and was able to walk without assistance. Twelve months after surgery, imaging revealed no evidence of tumor. CONCLUSION: The current treatment plan and recommendation, assuming this tumor will behave like a low-grade glioma or lipoma, is continued radiographic surveillance after gross total resection. Reresection is recommended for tumor recurrence or significant regrowth. The long-term prognosis for astrolipoma is unknown.     

Intramedullary spinal cord germinoma: case report

A case of intramedullary spinal cord germinoma within the conus medullaris, with lumbago and pain in the lower extremities, is presented. The intramedullary spinal cord germinoma was determined by a biopsy specimen. After local irradiation of 50 Gy, the tumor markedly decreased in size and clinical symptoms disappeared.     

Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases

A retrospective autopsy study of 627 patients with systemic cancer disclosed 153 patients with metastasis to the central nervous system (CNS) and 13 patients with intramedullary spinal cord metastasis (ISM). Thus, the frequency of ISM was 8.5% of cases of metastasis to the CNS and 2.1% of all cases of cancer. Bronchogenic carcinoma accounted for 11 cases of ISM, and breast carcinoma and melanoma for the other two. There were two distinct patterns of spinal cord involvement, indicating spread of tumor to the cord by two different routes. In nine of the 13 ISM patients a metastasis was found deep within the spinal cord, unassociated with leptomeningeal carcinomatosis; this most likely resulted from hematogenous spread of tumor from a pulmonary source. In the other four patients there was focal or multifocal direct extension of leptomeningeal metastatic tumor across the pia into the parenchyma of the cord. Only four of the 13 patients had a clinical myelopathy; in three of these four this was the presenting feature of an occult lung cancer.     

Intramedullary spinal cord metastasis of ovarian tumor

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a thoracic intramedullary spinal cord metastasis of ovarian tumor in a 59-year-old woman. SETTING: Shiga, Japan. CASE REPORT: A case of a thoracic intramedullary spinal cord metastasis of ovarian tumor in a 59-year-old woman is reported. She received abdominal ovariectomy for the ovarian adenocarcinoma 4 years before she suffered from back pain and showed neurological symptoms. The thoracic intramedullary lesion was confirmed by preoperative magnetic resonance imaging. She showed complete paralysis before operation. The excision of the tumor was achieved through the posterior approach. Histologically, the diagnosis of metastasis of adenocarcinoma was made. CONCLUSION: Although she did not show any postoperative neurologic recovery, her general condition was good and there was no evidence of recurrence 24 months after surgery.     

Intramedullary spinal cord metastasis: two case reports and literature review

Intramedullary spinal cord metastasis was thought to be rare, but the advent of MR imaging and treatment for malignancy have revealed that it is more frequent than we previously thought. We report two cases of intramedullary spinal cord metastasis from lung and rectal colon carcinoma. Their symptoms were aggravated rapidly. We performed surgical treatment in both cases; one was grosstotal and the other was subtotal resection. After the operation, symptoms improved mildly in one patient and worsened in the other patient. Both died 3 months after surgery, because of respiratory disturbance due to brain stem compression and lung metastasis. In conclusion, MRI is highly useful for making a diagnosis of intramedullary spinal metastatic tumors. However, it is still difficult to treat such a patient by surgery alone. Further postoperative adjuvant therapy will be necessary to improve the prognosis of such patients.     

Intramedullary abscess associated with a spinal cord ependymoma: case report.

Intramedullary spinal cord abscesses are relatively uncommon. We report the first case of an intramedullary spinal cord abscess in a preexisting spinal cord ependymoma. The clinical features and pathogenesis are discussed. Salient features of the management of intramedullary spinal cord abscesses are outlined.     

Intramedullary subependymoma of the cervical spinal cord: case report

The third case of intramedullary subependymoma of the cervical spinal cord is reported. This is the first such case for which intraoperative views are available. It was possible to remove most of this lesion with the aid of the operating microscope, the carbon dioxide laser, and the use of somatosensory evoked potentials. The diagnosis was clouded by the coexistence of Holmes-Adie pupils and absent reflexes in the lower extremities. All three reported intramedullary subependymomas have been found in the cervical spinal cord of middle-aged patients. Tumors in this clinical setting should not be assumed to be unresectable astrocytomas without careful histopathological and intraoperative evaluation.     

Intramedullary schwannoma of the spinal cord. A case report and review of the literature

A 9-year-old boy presented with the numbness in both arms and hands, and neck stiffness. On examination, he had a slight quadriparesis and restricted neck movements. There were no signs of von Recklinghausen's disease. Magnetic resonance imaging (MRI) scan disclosed a gadolinium enhanced intramedullary tumor located at C6-T1 associated with syringomyelia. C6-T1 laminectomies were performed and the intramedullary tumor was totally removed by a microsurgical technique. Postoperative course was uneventful. The pathological examination revealed an intramedullary schwannoma. The occurrence of intramedullary schwannoma in a patient without signs of von Recklinghausen's disease is extremely rare. We have been able to find 57 cases of intramedullary schwannoma reported in the literature. Intramedullary schwannomas are usually seen in males. The ages of the patients ranged from 9 to 75 years (mean 40.44 years). Only 4 cases in the pediatric age group have been reported. The duration of symptoms ranged from 3 months to 20 years (mean 31.03 months). Symptoms and signs varied with the location of tumor. The vertebral levels of intramedullary schwannomas were usually cervical (61%). MRI has been the choice of diagnostic tool in the cases reported since 1986. The majority of the cases showed either a partial or complete recovery in the postoperative period.     

Intramedullary ossified cavernous angioma of the spinal cord: case report

A case of a heavily ossified cavernous angioma of the spinal cord along with its histological features and surgical implications is reported. The unusually dense calcification and even bone formation along with the unique eggshell-like cyst formation posed problems in diagnosis and surgical excision. This calcified vascular lesion was treated by subtotal excision.     

Intramedullary spinal cord metastasis treated with radiation therapy: report of 3 cases

OBJECTIVES: Intramedurally spinal cord metastasis (ISCM) tends to be seen in the end period of the malignant tumor, so it is important to choose a therapeutic method regarding the QOL (quality of life) of the patient. In this study, we reported three cases of ISCM treated by radiation therapy alone, and demonstrated the utility of this therapeutic procedure. PATIENTS AND METHODS: From 2005 to 2006, 3 cases of ISCM underwent radiotherapy in our institution. The mean age of the patients was 64.0 years old, and all patients were men, having lung carcinoma as their primary lesions. The lesions were located at the cervical cord in one case and the conus medullaris in the other two cases. They were treated by radiotherapy at the department of radiology in our institute. RESULTS: The tumor size and intramedullary high signal area on MR images after the radiotherapy were reduced in all patients. During the clinical course, neurological symptoms were improved in two patients, and progression of the symptoms was stopped in one patient. All of the patients obtained a better ADL due to the radiotherapy. CONCLUSIONS: Radiotherapy has an advantage over surgical treatment in that it involves less invasion. The treatment brought improvements of clinical symptoms and radiological findings in the patients with ISCM. So, radiotherapy could be used as one of the major treatments for patients with ISCM who desire a better QOL after treatment.     

Intramedullary spinal cord germinoma--2 case reports

BACKGROUND: Primary intramedullary spinal cord germinoma is very rare. We encountered 2 patients with primary intramedullary spinal cord germinoma. We describe herein our comprehensive management system for CNS germinoma, including intramedullary spinal cord germinoma, along with a review of the literature. This is the first report to describe successful application of ICE chemotherapy for intramedullary germinoma. CASE DESCRIPTIONS: A 16-year-old adolescent girl (case 1) experienced lumbago and subsequently noticed gait disturbance that aggravated gradually. On admission, paraparesis and urinary retention were noted. Magnetic resonance imaging demonstrated marked cord swelling between T9 and T12, with slight enhancement in the spinal cord. Astrocytic tumor was initially suspected, and partial removal was performed. However, pathologic examination identified germinoma. Successful treatment with ICE chemotherapy and radiotherapy was implemented, with no evidence of recurrence apparent at 48 months postoperatively. A 34-year-old woman (case 2) presented with paraparesis and sensory disturbance. Magnetic resonance imaging demonstrated cord swelling between T8 and T10, with slight Gd-DTPA enhancement. Because the lesion did not respond to steroid pulse therapy, spinal cord tumor was suspected and biopsy was performed. Pathologic examination verified primary germinoma of the spine. Successful treatment with ICE chemotherapy and radiotherapy was implemented with no exacerbation of neurologic deficits. No evidence of recurrence was apparent at 36 months postoperatively. CONCLUSION: Correct diagnosis of very rare primary intramedullary spinal cord germinoma is important, because these patients can be treated successfully using chemo- and radiotherapy without neurologic deterioration.     

脊髓髓内孤立性纤维性肿瘤1例报道

正孤立性纤维性肿瘤(solitary fibrous tumors,SFT)是一种临床罕见的来源于间叶组织的梭形细胞肿瘤,1931年Klemperer和Rabin首次将其描述为一种来源于间叶细胞的纤维增殖性肿瘤~([1])。其主要发生在脏层胸膜,也可发生在全身各处~([2、3])。多数表现为良性,一般无明显临床症状~([4])。近期我院收治了1例脊髓髓内SFT,报告如下。患者女,62岁,因"左下肢无力11月余"于2016年     

Intramedullary clear cell ependymoma in the cervical spinal cord: case report

OBJECTIVE AND IMPORTANCE: Clear cell ependymoma of the spinal cord has not been reported in the literature, although ependymoma in the cerebral and cerebellar hemispheres has been described. We present the first case report of this rare histological type of ependymoma arising in the cervical spinal cord and emphasize the importance of recognizing this histological entity. CLINICAL PRESENTATION: A 42-year-old woman presented with numbness in both upper limbs and spastic gait. Magnetic resonance imaging revealed an intramedullary tumor at the C6-T1 level with syringomyelia. INTERVENTION: The tumor was totally removed. Histological analysis revealed that the tumor was composed of round cells with perinuclear halos similar to those observed in oligodendroglioma. However, we diagnosed clear cell ependymoma because these tumor cells exhibited epithelial features and ependymal rosettes under light microscopic examination. CONCLUSION: Histological diagnosis was crucial to our determining whether to perform postoperative adjuvant therapy in this patient. Neurosurgeons should be aware of the possibility of this histological entity among intramedullary spinal cord tumors.