Primary Subdural Extramedullary Neurocytoma: A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 4
Abstract
Neurocytoma as an extramedullary lesion is extremely rare in spinal canal. We present a case with primary subdural extramedullary neurocytoma of thoracic-lumbosacral spine. The patient presented with sore waist and numbness of right foot for half a month, as well as progressively increasing weakness of both lower limbs. An extramedullary tumor was revealed in the thoracic-lumbosacral level bymagnetic resonance imaging(MRI) and confirmed by pathology as extra ventricular Neurocytoma. In conclude, whenever a patient is diagnosed to have an extramedullary tumour in the thoracic-lumbosacral level, neurocytoma should be considered within the differential diagnosis despite its rarity.A 61-year-old male was referred to our hospital in September 2017, complaining sore waist associated with numbness of right foot, as well as progressively increasing weakness of both lower limbs for half a month. On examination, the patient presented with positive straight leg raising sign, increased deep tendon reflexes, and muscle strength in double lambs was rated as grade 3/4. The initial laboratory results were normal. MR images showed an extremely extensive extramedullary subdural lesion, which extended from T10 vertebral level to the S2 vertebral level. The spinal cord was normal and the tumor had a well-defined plane of cleavage with it. The tumor showed isointense signal on T1- weighted images (Figure 1A), slightly hyperintense signal intensity on T2-weighted images (Figures 1B&1D) and a hyperintense signal intensity on diffusion weighted images(DWI) (Figure 1C).It presented avidly heterogeneous enhancement on T1-weighted images after gadolinium administration (Figure 2) which clearly emphasized that the tumor was extramedullary. An operation was performed through T12 to L4 laminotomy. The tumor showed rich hypervascularity appearance and a clear boundary with nearby spinal cord on surgery. Because the lesion was too extensive to be entirely removed, a partial resection was performed. When discharged, the patient’s the neurological status was improved with negative straight leg raising sign, and muscle strength in double lambs was rated as grate 2/3. Microscopically, the tumor was made of sheets of small round or oval cells, and most of cells presented clear perinuclear halos. A cell-free zone composed of subtle fibrillary neuropils was found. The phenomenon such as calcification, mitosis, necrosis within lesion was not observed (Figure 3).Figure 1: Magnetic resonance image of the lumbar spine. A mass in thoracio-lumbosacral spine shows an isointense on. sagittal T1W image (A) and slightly hyperintense signal on T2W image (B). It shows a hyperintense signal on DW image (C) and corresponding decreased ADC value (D).
Authors and Affiliations
Sihua Yang, Jiawei Yang, Jian Hu, Guangyu Tang
Keywords
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- EP ID EP588480
- DOI 10.26717/BJSTR.2018.06.001394
- Views 139
- Downloads 0
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