Presentation
Progressive spacticity.
Patient Data
The abnormality is a large extramedullary intradural mass at T1 level markedly compressing the spinal cord. It shows homogeneous enhancement, heterogeneous high-signal on the T2-weighted sequence and measures 22 x 12 mm in cross-section, 23 mm in length. The rest of the spinal cord is unremarkable. Minimal extension through the left C7-T1 neural foramen.
The intervertebral discs are diffusely desiccated, with osteochondral bars in the mid cervical segment causing minor canal stenosis without spinal cord compression. Moderate bilateral foraminal stenosis at C4-5 to C6-7 levels from uncovertebral osteophytes.
Conclusion:
Severe spinal cord compression at T1 by large left spinal canal mass consistent with meningioma. A nerve sheath tumor is in the main differential diagnosis.
Case Discussion
The patient went on to have a resection, which confirmed the diagnosis of a spinal meningioma .
Histology
Paraffin sections show a moderately hypercellular meningioma. This has a well-developed syncytial architecture. Many calcified Psammoma bodies are also present. Tumor cells have uniform nuclear features. No mitotic figures or areas of necrosis are seen. Dural attachment is noted.
Final diagnosis: Meningioma (WHO Grade I - transitional / mixed histology).
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