These tumors usually arise from cells within the spinal cord. Pancreatic neuroendocrine tumor pnet is a rare tumor that usually presents with hepatic metastasis. Mar 27, 2020 resection of a large cervical spinal cord ependymoma tumor subtypes intramedullary spinal cord tumors are rare and challenging entities, comprising 16% to 58% of all primary spinal cord and 2% to 8. Intramedullary spinal cord tumors imscts exist within the spinal cord, while extramedullary spinal cord tumors emscts exist outside the spinal cord. Objectives intramedullary spinal cord tumors imsct are rare neoplasms that can potentially lead to severe.
We present two adult patients with spinal teratoma, and discuss the diagnosis of the condition. Intradural spinal tumours, although relatively uncommon, can be diagnostically challenging, and often result in significant morbidity. Pain often is the earliest symptom, characteristically occurring at night when the patient is supine. The most common are those originating from the spinal cord s supporting cells glia and therefore lie within the substance of the spinal cord itself.
Spinal cord tumors can occur within or adjacent to the spinal cord. The evolution of intramedullary spinal cord tumor surgery. The indications for spinal cord biopsy must take into. Intramedullary spinal cord metastasis most commonly occurs in the setting of advanced disease and only rarely is the first presentation of malignancy 7.
Surgery, once used for the diagnosis of intramedullary spinal cord tumors alone, now represents the most effective treatment of benign wellcircumscribed tumors which constitute the majority of intramedullary neoplasms. Because of slowgrowth, symptoms precede tumor discovery an average of 2 years. Jan 30, 2020 intramedullary spinal cord tumors, like the one depicted in the image below, refer to a subgroup of intradural spinal tumors that arise from cells within the spinal cord, as opposed to adjacent structures such as the nerve roots or meninges. Intradural extramedullary and intramedullary spinal cord. Genomic landscape of intramedullary spinal cord gliomas. Based on our experience with case 1, we performed biopsy alone in case 2. Spinal metastasis caused posterior neck and left shoulder pain, dysesthesia in both legs, and motor weakness in both legs and left arm, though the brain metastases were asymptomatic. All histological types have a long history of symptoms, which depends of locations in longitudinal plane. For highgrade astrocytomas, the prognosis is poor and no known cure is available. This article addresses their epidemiology, pathophysiology, clinical manifestations, diagnostics, treatment and future strategies. Thus, to the best of the authors knowledge, this is the first case of intramedullary. Intramedullary spinal cord metastasis of ovarian tumor. Whereas lung and breast cancer, malignant melanomas and lymphomas are reported as the most common primary tumors, the present series included three cases of breast carcinoma and two cases each of colon and oat cell carcinoma of the lung. With the help of these tools, most intramedullary spinal cord tumors may be diagnosed and treated surgically with significantly decreased risk.
Both the spinal and brain metastases were successfully treated by. Tumors in the spine comprise about 15% of all tumors in the central nervous system. Intradural extramedullary tumors tampa general hospital. Surgical management of intradural spinal cord tumors in children. Part iimanagement options and outcomes article pdf available in global spine journal 62 july 2015 with 149 reads how we measure reads. Intradural extramedullary tumors arise outside of the spinal cord but inside the dural sheath that surrounds the spinal cord, with the vast majority of these tumors slowgrowing and benign. Intramedullary spinal cord germinoma2 case reports. Intramedullary spinal cord metastases presenting as the first manifestation of malignancies are extremely rare lesions.
The intramedullary spinal cord is an unusual site of metastatic cancer. Twentysix patients with suspected lesions of the spinal cord were studied before and after administration of gadoliniumdtpa to assess whether contrast enhancement was useful in the mr evaluation of intramedullary disease. Intramedullary spinal cord tumors imscts are relatively infrequent lesions with ependymomas and astrocytomas representing the most common types. Despite intramedullary spinal meningioma cases being reported in humans, no intramedullary spinal meningioma case has yet to be reported in dogs. Intramedullary tumors are masses of tissue that form as a result of abnormal cell growth within the spinal cord. Germinoma should be considered as 1 differential diagnosis in cases of rapid deterioration in young patients with intramedullary lesion. Postoperatory outcome was excellent, and the histopathological result was. This report describes the pathologic findings in five autopsy cases with intramedullary spinal cord metastasis. Intramedullary spinal cord metastases iscms are rare complications of malignancy, affecting only 0. There are three main types of spinal tumors classified based on their location. Nerve sheath tumors nsts constitute approximately 25 percent of tumors arising in the intradural extramedullary space. Jul 12, 2012 intramedullary spinal cord tumor resection mari l. Primary spine tumors are rare neoplasms that can lead to significant patient morbidity and mortality.
They account for 20% of all intraspinal tumors in adults and 35% of all intraspinal tumors in children 8 a long duration of symptoms prior to diagnosis is typical. Intramedullary spinal cord tumors in neurofibromatosis. Intramedullary spinal cord tumors in nf have been reported as scattered, single cases in the. Spinal cord biopsy is a highrisk procedure with the potential to cause permanent neurological injury. Pdf intramedullary lumbar lesion mimicking spinal cord. For grade 12 tumors, the role of radiotherapy is controversial. They usually are benign and cause symptoms primarily. All intramedullary tumors presented spinal cord dilatation on mri. Functional outcome after surgical treatment of intramedullary spinal cord tumors. Morrison, cdr, mc, usn intramedullary spinal cord neoplasms are rare, accounting for about 4% 10% of all central nervous system tumors. Surgical treatment of intramedullary spinal cord tumors.
Intramedullary spinal cord germinoma clinically mimicking. We confined the clinicoradiological characteristics of each histological type. Intramedullary spinal cord tumors imscts are rare neoplasms that have limited treatment options and are associated with high rates of morbidity and mortality. Although the majority of nsts are confined to the intradural extramedullary space, some of these tumors. Myelographic interpretation may be difficult, and intramedullary tumors must be differentiated from spinal cord edema or hemorrhage. Adolescence, intramedullary tumor in childhood, pediatric neurosurgery, pediatric spine, spinal cord tumor, spinal instrumentation. They are much less common than brain tumors and are thought to account for only 24% of all intrinsic. These types of tumors can appear anywhere along the spinal cord but are most often found in the cervical area, where more neural tissue is present.
Intramedullary spinal tumors are rare, representing 410% of all cns tumors and less than 10% of all pediatric cns neoplasms 5. The first successful resection of a spinal cord tumor. Based on two cases reported from our department, we focused on the strategy for intramedullary spinal cord metastases surgery. Intramedullary spinal cord tumor resection youtube. The tumor capsule was followed to its superior and inferior margins, which determined the extent of the myelotomy. Rare reports have advocated the use of an anterior approach for anterior meningiomas. From the archives of the afip neoplasms of the spinal cord and filum terminale. Intramedullary spinal cord tumor the neurosurgical atlas. Mar 14, 2009 intramedullary spinal cord tumors leslie hutchins, md shore memorial cancer conference september 18, 2008 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The autopsy study of 627 patients with systemic cancer disclosed patients with intramedullary spinal cord metastasis. Despite their rarity, these lesions are important to the radiologist because magnetic resonance. Intramedullary spinal cord tumors are comprised predominantly of intrinsic gliomas such as astrocytomas and ependymomas.
Defintion a spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord andor spinal. We present for the first time a patient with multifocal intramedullary cervical spinal cord germ cell tumors with elevated serum alphafetoprotein afp. In recent years, there has been a remarkable improvement in the surgical outcomes of patients with intramedullary spinal cord tumors, due to advances in diagnostic imaging and microsurgical. They account for 20% of all intraspinal tumors in adults and 35% of all intraspinal tumors in children 8. Incontinence and decreased sensitivity in the saddle area buttocks are generally considered warning signs of spinal cord compression by the tumor. The tumor is characteristically taking up contrast a preinjection t1weighted sagittal image. Pain is typically local at tumor level, but may radiate. Groves, md department of neurological surgery, the johns hopkins hospital, baltimore, md, patricia l. Idiopathic transverse myelitis mimicking an intramedullary. Spinal cord tumors scts2 are rare, especially in children younger than three years.
More recently, combining routine magnetic resonance imaging mri and autopsy observation, it appears that metastatic imscts may be more. Unlike the situation in adults, lowgrade astrocytomas predominate followed by ependymomas and other. In the majority of cases, they are benign who grade 1 or 2 and the. Intramedullary spinal cord metastasis from pancreatic. Intramedullary spinal cord tumors and pseudotumors. Intramedullary spinal cord tumors are uncommon in children, and delayed diagnosis is common. Anatomically, these metastases are intradural, arising from cells within the spinal cord. In this case, an intramedullary c1c2 spinal cord germinoma was originally misdiagnosed as ms due to the presence of oligoclonal igg bands in csf. Romanian neurosurgery 2011 xviii 2 introduction although the intramedullary spinal cord sc tumors are relatively rare tumors, accounting for only 2% to 8. Intradural spinal cord tumors are classified on the basis of their location in relation to the spinal cord parenchyma. Spinal cord tumors may develop within the spinal cord parenchyma, directly destroying tissue, or outside the cord parenchyma, often compressing the cord or nerve roots. Symptoms of intramedullary spinal cord tumor are typically rapidly progressive, with the exception of 2 cases.
Primary spinal cord tumors account for 2 to 4 percent of all primary central nervous system cns tumors, onethird of which are located in the intramedullary. Intramedullary spinal cord tumors, like the one depicted in the image below, refer to a subgroup of intradural spinal tumors that arise from cells within the spinal cord, as opposed to adjacent structures such as the nerve roots or meninges. Intramedullary teratomas in the spinal cord are very rare, especially in adults over 50 years of age. Scranton and david baskin1,2 1department of neurosurgery, houston methodist hospital, houston, tx 77030, usa 2kenneth r. Intramedullary spinal cord tumour hemangioblastoma. Functional outcome after surgical treatment of intramedullary. Intramedullary spinal cord tumors are not common, but only gross total resection gtr can. In conclusion, idiopathic transverse myelitis may mimic spinal tumors by presenting as an intramedullary mass lesion of the spinal cord. Primary spinal cord tumors society for neurooncology. Intramedullary spinal cord tumors ependymomas ependymomas are rare, unencapsulated glial tumors of the brain, but they represent the most common form of imsct in adults and account for approximately 50% 60% of all intramedullary tumors. Symptoms can include progressive back pain and neurologic deficits referable to the spinal cord or spinal nerve roots. Intramedullary tumors, like all spinal cord tumors, can cause back pain and neurological symptoms like muscle weakness, tingling and loss of sensation. Intramedullary spinal cord neoplasms are rare, accounting for about 4%10% of all central nervous system tumors. This exhibit depicts a intramedullary tumor of the thoracic spinal cord.
Intramedullary spinal cord tumours imscts are rare primary spine neoplasms of the central nervous system cns and remain a clinical challenge due to. Intramedullary spinal cord metastases springerlink. Jun 12, 2018 intramedullary spinal cord abnormalities are often challenging to diagnose. The surgical treatment of intramedullary spinal cord. They can be subdivided according to their cell of origin and whether they are within the cord intramedullary.
Symptoms not specific to spinal cord tumors and may be present in any myelopathic process. They are considered to be intraaxial in location and can be either primary or metastatic. Extradural tumors are located outside the dura mater lining and are most commonly metastatic. Magnetic resonance imaging is the modality of choice for diagnosis and preoperative assessment of patients with spinal cord abnormalities. Primary site of tumor was the lung in four cases, and cancer of the. Intramedullary tumors involve the spinal cord, while extramedullary tumors arise outside of the spinal cord. Complete removal of a large intramedullary tumor ependymoma from the cervical portion of the spinal cord. Current insights into surgery for intramedullary spinal cord. Evidence of widely disseminated malignancy should increase. Nine patients had primary tumors, six had benign syringes, three had multiple sclerosis with cord. Two patients with intramedullary spinal cord tumor underwent resection. Preoperative study left demonstrates a relatively wellcircumscribed enhancing intramedullary lesion associated with syrinx and spinal cord. Imaging diagnosis of intramedullary spinal cord lesions could obviate.
Highgrade astrocytomas are soft, rapidly spreading tumors that can develop intracranial extensions. Spinal tumors are neoplasms located in either the vertebral column or the spinal cord. The diagnosis and management of intramedullary spinal cord tumors have been significantly influenced by new diagnostic and surgical tools such as mri, ultrasonic aspiration, intraoperative ultrasound, and. This illustration included sagittal section, posterior oblique view, and t910 axial view. In an autopsy series over a 30year period, the incidence of intramedullary metastasis among the metastatic tumors to the spine was 3. A retrospective analysis of 76 patients intramedullary spinal cord tumors imscts comprise about 20% of all intraspinal tumors ists, and. Stereotactic radiotherapy for cervical spinal intramedullary. Optimal management of patients with iscms remains ambiguous. In the other two patients, both with biopsyproven primary tumors and intramedullary spinal lesions shown. Pdf surgery of intramedullary spinal cord tumors nezih. They are usually benign and may involve only a short segment of the spinal cord or almost its entire length holocord tumor. Spinal cord involvement in nf is typically from extramedullary growth of spinal nerve root tumors. Microsurgical removal of intramedullary spinal cord gliomas in a rat spinal cord decreases onset to paresis, an animal model for intramedullary tumor treatment 4 march 2008 childs nervous system, vol. The symptoms seen are due to spinal nerve compression and weakening of the vertebral structure.
Intramedullary spinal metastasis radiology reference. However, like other spinal tumors, complications may arise as the tumor grows and puts pressure on the spinal cord. Optimum management of these patients remains ambiguous. Aug 24, 2004 functional outcome after surgical treatment of intramedullary spinal cord tumors. Intramedullary lumbar lesion mimicking spinal cord tumor. Peak brain and pituitary tumor treatment center, houston, usa abstract. Ependymoma of the cervical spinal canal in a teenager. Analogous to their extramedullary counterparts, three major histologic subtypes predominate. Surgical treatment of benign spinal cord tumors intechopen. The radiologists ability to narrow the differential diagnosis of spinal.
We report a patient who presented with an l5 radiculopathy, but after spinal imaging was found to have an intramedullary thoracic spinal. Diagnosis was established by cord biopsy in seven and by biopsy of other metastatic sites in three. Chemotherapy is reserved for recurrent intramedullary spinal cord tumors without other options. However, numerous imsct exist and the clinical course of each tumor varies. Intramedullary spinal cord metastasis springerlink. From january 1962 to may 1979, 23 patients with biopsyproved intramedullary spinal cord tumors were treated initially with total resection, subtotal resection, irradiation, or subtotal resection a.
Intramedullary spinal cord metastasis iscm is very rare and its optimal treatment remains controversial. The surgical treatment of intramedullary spinal cord tumors. Intramedullary spinal cord metastasis iscm is the rarest type of cns involvement by systemic malignant tumours. A case of intramedullary tumor provisionally diagnosed preoperatively by traditional methods and specifically as dermoid tumore with the assistance of magnetic resonance imaging is presented. Please call 18889990410 for custom sizing and other options. A clear plane was seen between the tumor and the spinal cord. A case of cervical c spinal intramedullary metastasis and multiple small brain metastases from papillary thyroid carcinoma was presented. Intramedullary spinal cord tumors are rare and challenging entities, comprising 16% to 58% of all primary spinal cord and 2% to 8. Successful treatment of childhood intramedullary spinal cord. The authors report a 74yearold woman who presented with an isolated intramedullary spinal cord metastasis which presents as first manifestation of malignancy without central nervous system andor other organ involvement. In contrast to the long duration of symptoms that are typical of primary intramedullary spinal neoplasms, up to 75% of patients with a spinal cord metastasis have symptoms for less than one. Isolated solitary intramedullary spinal cord metastasis. Intramedullary spinal tumors radiology reference article. Intramedullary spinal cord metastasis in the dog waters.
Pre and postoperative t 1weighted images of a patient with cervicothoracic region ependymoma, after contrast injection. Symptoms like these can progress to the point that they are devastating if left untreated. Much literature is not available due to the rarity of these tumours. Intramedullary dermoid tumor diagnosed with the assistance. Data were collected consisting of age, sex, location and histology of tumor, extent of. If your doctor has diagnosed you with an intramedullary tumor, the next step is to decide how to treat it.