Thoracic spine meningioma - recurrence
Late MRI surveillance after a previous benign spinal tumour resection 10 years ago. Asymptomatic.
MRI Thoracic spine
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Previous T9-T11 decompressive laminectomy again identified. There is a homogeneously enhancing slightly T2 hyperintense circumscribed extradural mass occupying the left half of the spinal canal and extending through the left T9/T10 exit foramen. At the superior extreme of the mass, a tiny enhancement extends along the inferior margin of the left T 8/9 exit foramen. The component within the spinal canal has maximal axial dimensions of 14.5 x 15.5 mm and a craniocaudal extent of 29 mm.
A separate smaller enhancing lesion located anteriorly in the spinal canal immediately inferior to the main lesion measures 8 x 7 x 4 mm, and appears to be intradural.
The spinal cord is displaced into the right side of the spinal canal, with a distorted contour but no compression. There is no convincing intrinsic cord signal abnormality.
At the level of the T7 vertebral body, there is a prominent enhancing vessel applied to the left dorsal aspect of the cord, of dubious clinical significance.
No change to the enhancing T 2 hyperintense lesion within the left T10 transverse process, most likely be a haemangioma.
Small T5-6 and C6-7 left paracentral disc protrusion is and right T8/T9 paracentral disc protrusion again noted.
Conclusion: Recurrent meningioma occupying the left side of the spinal canal at T9 level with extension into the left T9/T10 and to a lesser extent T8/9 intervertebral foramina, displacing and distorting the cord without compression or intrinsic cord signal abnormality. There is a smaller anterior intradural component just below the main lesion.
Histology: The sections show a moderately cellular meningioma. The tumour forms whorls. No sheeting arrangement is seen. The tumour cells have ovoid nuclei with no nuclear pleomorphism. There are up to 3 mitoses per 10 high power fields. No necrosis is seen. The tumour is present in the connective tissue. It is adjacent to but not invading into nerve bundles. No evidence of atypical or malignant meningioma is identified. The tumour cells are progesterone receptor negative. The topoisomerase index is 2%.
Diagnosis: Spinal tumour: Meningioma (WHO Grade I).
Spine meningiomas are slow-growing benign tumours usually resected surgically, and experiencing a recurrence index in about 10% of the cases. The main differential is made with spinal schwannomas, which can look very similar.