Spinal astrocytoma - thoracic

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Two 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 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.

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 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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