Paraganglioma of the cauda equina
Left leg pain and numbness with associated saddle numbness.
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An 18 x 27 x 19mm intradural mass is seen at the level of the L2 vertebral body, the inferior margin of the lesion at the level of the L2/3 disc. The lesion has heterogeneous internal signal with some cystic change. There is vivid in enhancement, other than in the area of cystic change.
MACROSCOPIC DESCRIPTION: An ovoid fragment of dark brown tissue 27x18x18mm, with a narrow cyclindrical stalk 15x2x2mm, extending to the cranial end, marked with a suture.
MICROSCOPIC DESCRIPTION: The sections show a moderately cellular tumour comprising packets and clusters of cells showing mild nulcear plemorphism and surrounded by moderate amount of eosinophilic granular cytoplasm. There is a conspicuous vascular network surrounding tumour clusters. No mitotic figures are identified. There is no necrosis. The tumour is completely excised.
The tumour cells show strong and diffuse immunostaining for neuroendocrine markers synaptophysin and chromogranin. Most of the tumour clusters show S-100 positive sustentacular cells at the periphery. The tumour cells are negative for EMA. The features are of paraganglioma.
FINAL DIAGNOSIS: Paraganglioma.
Paragangliomas, although rare, do occur in the cauda equina region and can mimic schwannomas.