Updated: 6/24/2021

Spinal Cord Tumors

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Evidence
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Cases
1
Topic
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  • Epidemiology
    • Primary central nervous system (CNS) tumor of the spine is classified as
      • intradural extramedullary
      • intradural intramedullary
      • extradural
    • Epidemiology
      • primary CNS tumors most common intracranially
        • 2-4% occur in the spine
        • 850-1,700 diagnosed in United States annually
  • Intradural Extramedullary Tumors
    • Epidemiology
      • account for 60-70% of all primary CNS spinal cord tumors
      • typically present with symptoms related to
        • central cord compression
        • radicular pain
        • deep seated back pain
          • most intense at night
        • associated cauda equina-like symptoms
    • Schwannoma
      • incidence
        • most common intradural tumor along with meningiomas
        • peak incidence in 40s-50s
        • equal occurrence between men and women
        • most are benign, with malignant subtypes
        • arise from dorsal nerve root
        • may be associated with
          • neurofibromatosis type II
      • imaging
        • MRI exhibits mass arising from dorsal root
          • T1 shows isotense mass
          • T2 shows hyperintensity
        • common locations:
          • cervical spine (31%)
          • cauda equina (24%)
          • thoracic spine (22%)
          • upper cervical spine (16%)
          • conus medullaris (4%)
      • histology
        • difficult to distinguish from neurofibroma
        • biphasic, Antoni A (hypercellular) and B (hypocellular) pattern
        • elongated nerve cells in collagen background
        • S-100 positive
      • treatment
        • surgical resection
        • post-operative radiation for malignant tumors
    • Meningioma
      • incidence
        • accounts for 25% of all primary spinal cord tumors
        • most often occurs in:
          • women (80%)
          • thoracic spine
        • peak incidence during 5th and 6th decades of life
        • risk factors include:
          • neurofibromatosis type II
          • previous history of radiation
      • imaging
        • MRI
          • well-circumscribed, dura-based lesion
          • on T1, iso- or hypointense
          • on T2, slightly hypertensive with homogenous enhancement with contrast
      • histology
        • lobulated architecture
        • may contain meningothelial whorls
      • treatment
        • if symptomatic, surgical resection
        • can be curative with complete resection
        • for recurrence, radiation should be considered
  • Intradural Intramedullary Tumors
    • Epidemiology
      • account for 20-30% of all intradural tumors in adults and 50% in children
      • typically present with symptoms related to:
        • local or radicular pain
        • motor deficits (65%)
        • sensory deficits (60%)
        • sphincter dysfunction (38%)
          • often initial symptom
    • Ependymoma
      • incidence
        • most common intradural intramedullary primary CNS tumor
        • classified as:
          • benign
            • myxopapillary (40-50%)
            • cellular (42%)
          • malignant
            • anaplastic
      • imaging
        • myxopapillary
          • on MRI, encapsulated lesion in the filum terminale
          • on T1, hypo- or isointense
          • on T2, hyper intense
          • heterogeneous on contrast enhancement
          • other features typically seen are:
            • vertebral body scalloping
            • neural foraminal enlargement
            • scoliosis
            • tumor seeding in the sacrum
        • cellular
          • on MRI, similar to myxopapillary
            • distinguishing characteristic
              • polar cysts
              • hemorrhage
      • histology
        • cellular, monomorphic cells
        • characteristic rosettes and pseudorosettes
      • treatment
        • gross total resection
          • good prognosis, especially if planes are maintained
    • Astrocytoma
      • incidence
        • most are benign (30%)
        • peak incidence in third decade of life
        • most common in children (80-90% of intramedullary tumors)
      • imaging
        • on MRI
          • fusiform appearance with irregular margins
          • On T1, hypo- or isointense
          • On T2, hyper intensive with variable contrast enhancement
          • typically found in cervicothoracic junction in children
      • histology
        • hypercellular, mitotic figures
        • eosinophilic granules are common
      • treatment
        • gross total resection difficult due to infiltrative nature
        • radiation typically used to supplement surgery
        • chemotherapy may be beneficial
  • Extradural Tumors
    • Metastasis
      • extramedullary
        • representative of advancing systemic disease
        • 'drop' metastases from cranial lesion possible
          • spread via CSF
      • intramedullary
        • rare, <1% of all systemic malignancies
        • most commonly from:
          • lung
          • breast
      • imaging
        • rapidly expanding, progressive on MRI
        • intramedullary commonly found in cervical region and conus medullaris
      • treatment
        • surgical resection rare
        • control burden with radiation and/or chemotherapy
        • intramedullary metastases associated with less than 3 month life expectancy
    • Lymphoma
      • incidence
        • rare
      • imaging
        • entire neuroaxis should be analyzed via MRI
        • on T2, ill-defined hyperintense lesion with marked homogeneous contrast enhancement
        • less cord enlargement
        • usually found in cervical spine
      • treatment
        • methotrexate
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