Spinal astrocytoma (thoracic)

Case contributed by A.Prof Frank Gaillard

Presentation

2 weeks of increasing lower limb numbness and weakness.

Patient Data

Age: 25 years
Gender: Male
MRI

T2 hyperintense expansion of the thoracic cord is demonstrated. The main mass effect is centred  between T5 and T8 but abnormal high T2 signal extends between T4 and T11. Postcontrast images demonstrate patchy irregular peripheral enhancement of this lesion, and central low intensity.  No definite evidence of blood products/haemorrhage although some T2 hypointensity is seen.No further intra medullary lesion is identified.

Annotated image

A mass with high T2 signal ( * ) is located eccentrically within the cord, with 'normal' appearing cord displaced posteriorly and to the left (blue arrows). The mass demonstrates heterogeneous contrast enhancement (red arrows). 

The patient went on to have a biopsy of the lesion. 

Histology

MICROSCOPIC DESCRIPTION: The section shows very small fragments of moderately hypercellular  tissue. In  several fragments there are hypercellular areas composed of cells with  moderate nuclear pleomorphism. Cells in these areas show strong  immunostaining forGFAP, indicating astrocytic lineage, and an  elevated Ki-67/MIB-1 labelling index (approximately 8%). No mitotic  figures or areas of necrosis are seen.  Thin-walled vessels are noted  in some fragments. No vascular endothelial cell hyperplasia is seen.  The features are strongly suggestive of astrocytoma. 

FINAL DIAGNOSIS: Spinal cord astrocytoma.

Case Discussion

This case illustrates fairly typical features of a spinal cord astrocytoma. 

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Case information

rID: 19505
Case created: 17th Sep 2012
Last edited: 24th Nov 2016
Tag: spine
Inclusion in quiz mode: Included

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