Spinal cord glioblastoma

Case contributed by Dr Yune Kwong

Presentation

3-month history of urinary difficulties culminating in acute admission with urinary and faecal incontinence.

Patient Data

Age: 57-year-old
Gender: Male

MRI Total spine

Modality: MRI

T2 images show a hyperintense lesion in the conus, with slight expansion. This enhances following contrast administration. The intense solid-like enhancement does not favour demyelination or other inflammatory disorder. A tumour such as ependymoma was considered at the time of imaging.

Patient was treated with high dose steroids, and re-imaged one month later.

Modality: MRI

On this follow up scan, the conus is even more hyperintense and expanded. The area of enhancement has also increased, and note the increased vascularity of the pial vessels leading up to the lesion. On the axials, a small non-enchancing necrotic area has developed on the right side of the lesion. New enhancement of the cauda roots is also seen, suggesting leptomeningeal dissemination.

An interesting associated finding is thoracic epidural lipomatosis secondary to the high dose steroids. The proliferation of epidural fat dorsal to the thoracic cord causes the CSF anterior to the cord to be effaced (compare with original study).

Case Discussion

The appearances following the second scan were strongly in favour of an intrinsic cord tumour (CT body was negative). The patient went for a debulking, and the histology showed glioblastoma (GBM). This is an example of a common tumour in an uncommon location. In retrospect, the imaging findings were all those expected for a GBM if seen in the brain.

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Case Information

rID: 26715
Case created: 3rd Jan 2014
Last edited: 10th Dec 2015
Inclusion in quiz mode: Included

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