Spinal low grade chondrosarcoma

Case contributed by Dr Ernest Lekgabe

Presentation

Background history of cervical tumour resection as in childhood - hsitology unknown. Presented with symptoms and signs of myelopathy. Recurrent cervical tumour on MRI. Underwent laminectomy and resection. Postoperative course complicated by orthostatic headache.

Patient Data

Age: 60
Gender: Male
CT

CT Cervical Spine

Evidence of previous C7/T1 laminectomy. Partly calcified lesion in the right C7/T1 lateral recess.

MRI

MRI cervical spine (with contrast)

Evidence of previous C7/T1 laminectomy. Lobulated markedly T2 hyperintense peripherally enhancing lesion in the right C7/T1 lateral recess, in keeping with tumour recurrence.

Surgical resection of the tumour was performed and confirmed to be chondroma on histology.

MRI

MRI cervical spine (with contrast) - 6 months post op.

Large postsurgical pseudomeningocele.

MRI

MRI cervical spine (with contrast) - 9 months post op.

Evidence of previous C7/T1 laminectomy. Previously demonstrated large pseudomeningocele extending posteriorly through the laminectomy defect has increased in size, now measuring approximately 58 x 45 x 60 mm (AP x ML x SI), previously measuring 48 x 40 x 49 mm (AP x ML x SI). The lesion extends through the right epidural space at C7/T1 level with mild flattening and displacement of the cord to the left side. A large thecal defect allows free communication between the subarachnoid space and the pseudomeningocoele. It partially wraps around the right anterior aspect of the cord and extends through the right C7/T1 intervertebral foramen, with bony remodelling and widening of the exit neural foramen, into the paravertebral space and extending along the T1 nerve root. The epidural/foraminal/extraforaminal component has also increased in size since the previous study, now measuring 30 x 16 x 15 mm and previously 22 x 14 x 6 m. Enhancement of the wall of the pseudomeningocele is also more prominent than previously. No new cervical lesion.

Conclusion: Increased size of the C7/T1 pseudomeningocele communicating with the subarachnoid via a large defect.  Increased size of the epidural/foraminal/extraforaminal component with Increased enhancement, suggestive of tumour recurrence.

MRI

MRI cervical spine (with contrast) - 9 months post op.

Small volume of blood laying in both occipital horns of the lateral ventricles and susceptibility artefact around the brain stem in keeping with superficial siderosis.

Pathology

Re resection was performed (third operation altogether).

Tumour sections show nodular fragments of a moderately cellular chondroid neoplasm. Tumour cells are set within a variably loose myxoid to dense cartilaginous stroma. Frequent binucleated tumour cells are present. Scattered mitotic figures are identified. Tumour cells contain enlarged, hypochromatic, angulated nuclei.

Immunohistochemistry results show tumour cells stain: S100+, M2A+, CAM5.2- and Ki67 40-50%.

Case Discussion

DIAGNOSIS: Low-grade chondrosarcoma.

Intraventricular blood and superficial siderosis around the brain stem, shown on MRI brain before the last operation, was most likely related to the presence of pseudomeningocoele. The relationtioship between the two has been well described.

PlayAdd to Share

Case information

rID: 55668
Case created: 20th Sep 2017
Last edited: 24th Sep 2017
System: Spine
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.