Presentation
Two weeks of increasing lower limb numbness and weakness.
Patient Data
T2 hyperintense expansion of the thoracic cord is demonstrated. The main mass effect is centered 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/hemorrhage although some T2 hypointensity is seen. No further intramedullary lesion is identified.
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 labeling 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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