Presentation
Sensory level at T10.
Patient Data
A tumor mass centered at T9 causes severe cord compression, the cord being displaced to the left side, occupying less than 25% of the cross sectional area of the spinal canal at this level. The tumor mass has two components, that within the dura is slightly hyperintense whereas that external to the dura extending through the T9/10 exit foramen is more hyper intense. Both components demonstrate similar vivid and sharply defined contrast enhancement, demonstrating a connection between the intra and extradural components. The mass extends from the superior border of T9 to the upper border of T10. The cord and spinal canal above and below down are normal.
Enhancing soft tissue mass markedly displaces the cord towards the left (green dotted line). It has both an intradural and extradural (foraminal) component with the theca visible as a dark line (blue arrows). Prominent dural tails are visible on sagittal imaging (orange arrows).
The patient went on to have a laminectomy and excision of the tumor.
Histology
MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular meningioma with a well developed syncytial architecture. Scattered calcified psammoma bodies are also noted. Tumor cells have uniform nuclear features. No mitotic figures or areas of necrosis are identified. Extension into the cortex of bone is noted.
FINAL DIAGNOSIS: spinal tumor: meningioma.
Case Discussion
This case illustrates the difficulty in distinguishing meningiomas from nerve sheath tumors when the former passes into the foramen.
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