Epidural spinal meningioma. Role of magnetic resonance in differential diagnosis

Extradural cervical spinal meningioma mimicking malignancy

The vast majority of intraspinal meningiomas occur in an intradural extramedullary location. A meningioma in a purely extradural location in the cervical spine as reported here is quite exceptional. Extradural meningiomas tend to show more aggressive features than intradural meningiomas and are often confused with malignant neoplasms. We report an invasive extradural meningioma in the cervical spine with multi-segmental involvement, extension through the neural foramina and encasement of the subjacent vertebral artery, mimicking malignancies such as lymphoma and sarcoma. Although rare, meningiomas may demonstrate extradural multi-segmental growth and should be considered in the differential diagnosis of such lesions.

Multiple Extradural Spinal Meningiomas in a Patient with Acquired Immunodeficiency Syndrome: Case Report and Literature Review

BACKGROUND

Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine.

CASE DESCRIPTION

A 40-year-old male with a past medical history of HIV and hepatitis B infection presented with a 2-month history of progressive back pain radiating to the left flank and thigh. Magnetic resonance imaging of the thoracic and lumbar spine with intravenous gadolinium contrast revealed 2 extramedullary masses in the left neural foramina of T6 and L1. The patient underwent laminectomy, which revealed that the 2 lesions were entirely extradural. Both lesions were resected, and the histological diagnosis for both lesions was meningioma, World Health Organization grade I.

CONCLUSIONS

Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.

Spinal tumour: primary cervical extradural meningioma at an unusual location

Extradural spinal meningiomas are extremely rare, more so in the cervical region. A purely extradural location as reported in this paper is quite exceptional. The authors report a case of extradural meningioma in a 50-year-old male located in the cervical spine that was surgically treated with the provisional diagnosis of a neurofibroma. Histopathological diagnosis of meningothelial meningioma was made with the routine hematoxylin and eosin (HE) stain. The origin, clinical course, radiological features, pathological findings with the differential diagnosis and surgical treatment are discussed based on a review of the literature. An extradural spinal meningioma, an extremely rare entity, is still a diagnostic dilemma on radiology as the radiologic findings overlap with many other common extradural spinal masses.

CT and MRI findings of calcified spinal meningiomas: correlation with pathological findings

OBJECTIVE

This study was designed to present characteristic CT and MR findings of calcified spinal meningiomas that correlate with pathological findings and to assess the efficacy of CT for the detection of calcifications within a mass in comparison to MRI.

MATERIALS AND METHODS

Between 1998 and 2009, 10 out of 11 patients who had pathologically confirmed psammomatous meningiomas showed gross calcifications on CT images and were included in this study. On CT scans of the 10 patients, the distribution pattern, morphology and number of calcifications within masses were evaluated. MRI was performed in seven patients and signal intensities of masses were assessed. The pathological results analyzed semi-quantitatively were compared with the density or the size of calcifications within a mass as seen on a CT scan.

RESULTS

Seven of 10 masses were located at the thoracic spine level. Eight masses had intradural locations. The other two masses had extradural locations. Four masses were completely calcified based on standard radiographs and CT. Symptoms duration, the size of the mass and size or number of calcifications within a mass had no correlation. The location, size, and distribution pattern of calcifications within masses were variable. On MR images, signal intensity of calcified tumor varied on all imaging sequences. All the masses enhanced after injection of intravenous contrast material.

CONCLUSION

A calcified meningioma should be first suggested when extradural or intradural masses located in the spine contain calcifications regardless of the size or pattern as depicted on CT, especially in the presence of enhancement as seen on MR images.

Cervical extradural meningioma with rapidly progressive myelopathy

A 50-year-old man noticed numbness of both hands. Muscle strength in the upper and lower extremities progressively deteriorated, and he became unable to stand or hold a cup over a five-day period. MRI showed an extradural tumour encasing the anterior, posterior and right lateral aspects of the cervical spinal cord, maximal at C3-4 but extending to C1, and emerging from the right C3-4 intervertebral foramen. At surgery, the tumour was entirely extradural. Histological examination revealed a meningioma. The patient recovered without neurological deficit with no recurrence 3 years after surgery.

Imaging features of spinal epidural cavernous malformations

Cavernous angioma or cavernoma is a vascular malformation that may affect any area in the neuraxis. Epidural location is very rare and therefore seldom considered in the differential diagnosis of spinal cord compression. We report two cases of epidural cavernous angiomas. The first case is a solitary and purely epidural dorsal cavernous angioma without foraminal expansion or bone modification causing spinal cord compression in a 35 year old woman. The second case is a solitary epidural dorsal cavernous angioma with foraminal extension causing spinal cord compression in a 56 year old woman. Histological confirmation is available for both cases. We describe the MRI features of this lesion insisting on its differential diagnosis on imaging.

Purely epidural spinal meningioma mimicking metastatic tumor: case report and review of the literature

STUDY DESIGN

Case report.

OBJECTIVES

To report a rare case of purely extradural spinal meningioma in a patient with previous history of malignant disease and to discuss the potential pitfalls in differential diagnosis and treatment of intraspinal extramedullary masses.

SUMMARY AND BACKGROUND DATA

Spinal meningiomas located purely in the extradural space are rare, and they may easily be confused with malignant neoplasms that are much more common in this location.

METHODS

An asymptomatic intraspinal extramedullary mass in the thoracolumbar region was detected by magnetic resonance imaging in a 75-year-old woman with previous history of malignant disease.

RESULTS

The purely extradural lesion was completely excised via a dorsal approach. The intraoperative and postoperative histologic examination revealed a meningioma. The patient is symptom free 18 months after surgery without radiologic recurrence.

CONCLUSION

Extradural spinal meningiomas may mimic metastatic disease. Attention needs to be drawn to this dangerous preoperative and intraoperative misinterpretation, which may easily entail an inadequate therapy. Intraoperative histology is mandatory for optimal surgical decision-making.