Presentation
Progressive lower limb weakness for 5 weeks. No history of trauma or fever
Patient Data
T3/T4 intradural-extramedullary homogenously enhancing lesion displacing the cord laterally to the right. There are no areas of dephasing on all sequences to indicate intra-lesional calcifications. No associated expansion of neural foramina or the 'Ginkgo leaf sign'. No remodeling or scalloping of the posterior vertebral body. Minor degenerative changes of the cervical spine.
Normal spinal alignment with no destructive bone lesion, posterior vertebral body scalloping or degenerative changes. No prevertebral collection or masses.
The patient has surgery and resection of the intra-dural extramedullary lesion.
Histology:
Macroscopy: Specimen labeled spinal cord tumor consists of small fragments, largest polypoidal fragment measuring 10 mm x 10 mm x 5 mm.
Microscopy:
Sections show predominantly lesional fragments of tissue with associated dura. The neoplastic proliferation comprises a whorled pattern of bland meningothelial cells with indistinct cell borders, round to oval nuclei and pseudonuclear inclusions. No necrosis, atypia or mitotic figures are seen. No spinal cord parenchyma is present.
Pathological diagnosis: Meningothelial meningioma, WHO grade 1.
Case Discussion
The imaging findings are in keeping with an intradural extramedullary lesion. The differential diagnoses include schwannoma, neurofibroma, malignant peripheral nerve sheath tumor. and leptomeningeal metastasis. Histology confirmed the tumor to be a meningioma, WHO grade 1.