Spinal meningioma

Case contributed by A.Prof Frank Gaillard

Presentation

Left sided upper limb weakness and paresthesia.

Patient Data

Age: 60 years
Gender: Female
MRI

Pre- and post contrast sagittal and axial MRI of the cervical spine has been performed.

The finding of note is that of a vividly-enhancing T2 hyperintense lobulated intradural extramedullary tumour centred in the left side of the spinal canal at the C5/6 vertebral level, with enhancement extending along the exiting left C6 nerve root.  The tumour severely compresses and displaces the spinal cord into the right side of the spinal canal at this level, with no overt cord signal abnormality demonstrated. 

The remainder of the study is unremarkable, apart from age-related intervertebral degenerative changes in the mid to lower cervical spine and relatively prominent haemangiomata in the C5 and C7 vertebral bodies, with normal craniocervical junction and remaining cervical spinal cord.. 

MICROSCOPIC DESCRIPTION:   Paraffin sections show a moderately hypercellular meningioma.  The tumour cells form whorls, fascicles and sheets of bland  meningothelial cells embedded in dense paucicellular collagenous  stroma. There is mild nuclear pleomorphism. Only one mitotic figure is identified in the whole tumour field. There is no necrosis.

FINAL DIAGNOSIS: Spinal tumour: Meningioma (WHO grade I).

Annotated image

Ginko leaf sign of meningioma, with the cord representing the leaf and the stretched hypointense dentate ligament extending through the enhancing tumour as the stem. 

Photo credit:

Author: Emke Dénes  (2011)

Original file: here

Modifications: square crop and levels. 

License: "I, the copyright holder of this work, hereby publish it under the following licenses: This file is licensed under the Creative Commons Attribution-Share Alike 2.5 Generic license.

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Case Discussion

Fairly typical appearances of a spinal meningioma, with recognition of a dural tail and ginko leaf sign helpful in making the preoperative diagnosis. 

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Case information

rID: 19691
Case created: 4th Oct 2012
Last edited: 17th Feb 2016
Tag: spine
Inclusion in quiz mode: Included

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