Paraganglioma of the cauda equina

Case contributed by A.Prof Frank Gaillard

Presentation

Left leg pain and numbness with associated saddle numbness.

Patient Data

Age: 70 years
Gender: Male

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.

Case Discussion

Paragangliomas, although rare, do occur in the cauda equina region and can mimic schwannomas. 

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Case information

rID: 19546
Case created: 22nd Sep 2012
Last edited: 4th Nov 2015
Tag: spine
Inclusion in quiz mode: Included

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