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Fareez F, Yahya S, Fong C, Moodley J, Provias J, Popovic S, Cenic A, Lu JQ. Spinal calcifying pseudoneoplasm of the neuraxis (CAPNON) associated with facet joint pathologies: CAPNON diagnostic and pathogenic insights. Hum Pathol 2024; 145:16-25. [PMID: 38336278 DOI: 10.1016/j.humpath.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like fibro-osseous lesion that can develop anywhere in the neuraxis. Approximately a half of reported CAPNONs developed in the spinal region, mostly close to the facet joint (FJ). The diagnosis of spinal CAPNONs is challenging given the existence of mimics and associated pathologies including calcific degeneration of the FJ ligaments (DFJL) and synovial cysts (SCs). The pathogenesis of CAPNON remains elusive, although there have been a few hypotheses including degenerative, reactive, proliferative and immune-mediated processes. Our present study examined clinical, radiological and pathological features of 12 spinal CAPNONs in comparison to 9 DFJL foci, and diagnostic and pathogenic relationship between CAPNONs and FJ pathologies. On imaging, CAPNONs were all tumor-like and typically bigger than DFJL foci. All CAPNONs showed pathologically diagnostic features including characteristic cores, consistently identifiable core-surrounding/peripheral palisading of macrophages and other cells including multinucleated giant cells, variable infiltration of CD8+ T-cells, and multifocal immunopositivity of neurofilament light chain (NF-L). These features were absent or limited in the DFJL foci with statistically significant differences from CAPNONs, except calcifications. Spinal CAPNONs co-existed with DFJL foci in all cases; some had transitional foci with overlapping focal CAPNON and DFJL-like features. These findings, along with our previously reported relationship between CAPNONs and SCs, suggest that spinal CAPNONs may occur in association with or in transition from calcifying/calcified degenerative lesions of FJ ligaments and/or SCs when a reactive proliferative process is complemented by other pathogenic changes such as immune-mediated pathology and NF-L deposition/expression.
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Affiliation(s)
- Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jinesa Moodley
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - John Provias
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Surgery/Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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Riviere-Cazaux C, Carlstrom LP, Eschbacher KL, Raghunathan A, Graffeo CS, Meyer FB. Calcifying Pseudoneoplasm of the Neuraxis: An Institutional Series of Ten Cases and Review of the Literature to Date. World Neurosurg 2023; 180:e653-e666. [PMID: 37813339 DOI: 10.1016/j.wneu.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Calcified pseudoneoplasms of the neuraxis (CAPNONs) are rare, fibro-osseous lesions with an unknown cause that may present anywhere along the neuroaxis. Little is known about how intracranial CAPNONs present and about patients' long-term outcomes. METHODS A retrospective institutional review of intracranial pathology-confirmed CAPNONs was performed. Presenting clinical features, management, and clinical outcomes are highlighted. A literature review of intracranial CAPNON lesions was also performed to build on our series. RESULTS Ten patients were identified who met the inclusion criteria. Most patients presented with headaches (n = 6; 60%), seizures (n = 5; 50.0%), and neck and facial pain (n = 3; 30.0%). Most lesions were supratentorial (n = 7; 70.0%), with 3 infratentorial origins. Surgical resection was the most common initial management undertaken (n = 7; 70.0%). No new permanent postoperative neurologic deficits were identified. The median clinical and/or radiographic follow-up for all patients was 6.8 years (range, 0.7-23.3 years), with no recurrence of disease for 5 patients who underwent gross total resection. Four of 5 patients with residual or nonresectable lesions showed no interval growth on radiographic follow-up; 1 patient showed progression and worsening of presenting symptoms 2 months after resection. Resection substantially improved seizures and headaches in patients presenting with these symptoms (80% and 83.3%, respectively). CONCLUSIONS Intracranial CAPNONs may present with a wide variety of symptoms characteristic of the site of origin. The outcomes of these symptoms regarding survival and disease control are generally favorable, although resection does not always yield complete resolution of presenting deficits in certain patients, particularly those presenting with headaches or neck/facial pain.
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Affiliation(s)
| | - Lucas P Carlstrom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher S Graffeo
- Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Fredric B Meyer
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Sun X, Xu C, Cai Y, Pan Z, Li Z. Meningioangiomatosis Combined with Calcifying Pseudoneoplasms of Neuraxis. Brain Sci 2023; 13:brainsci13050786. [PMID: 37239258 DOI: 10.3390/brainsci13050786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Meningioangiomatosis (MA) is a rare hamartomatous or meningovascular lesion involving the central nervous system, and is sometimes associated with intracranial meningiomas. Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, slow-growing benign tumor-like lesions that can occur anywhere along the neuraxis. Here, we report a rare case of MA combined with CAPNON. A 31-year-old woman was admitted to our hospital because of a high-density mass in the left frontal lobe, detected by computed tomography (CT) during a physical examination. She had a 3-year history of obsessive-compulsive disorder. We describe the imaging, histopathological, and molecular characteristics of the patient. To our knowledge, this is the first report describing MA combined with CAPNON. We reviewed the literature on MA and CAPNON over the last decade and summarized the points for differential diagnosis and treatment. It is difficult to preoperatively distinguish between MA and CAPNON. However, this coexisting condition should be considered when intra-axial calcification lesions are observed on radiological imaging. Accurate diagnosis and appropriate treatment are likely to benefit this patient group.
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Affiliation(s)
- Xiangyu Sun
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430062, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430062, China
| | - Yuxiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China
| | - Zhiyong Pan
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430062, China
| | - Zhiqiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430062, China
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Gamblin A, Gropp J, Fredrickson VL, Baradaran H, Couldwell WT. Calcifying Pseudoneoplasm of the Neuraxis Presenting with Vasogenic Edema and a Perilesional Cyst. Asian J Neurosurg 2022; 17:507-510. [PMID: 36398171 PMCID: PMC9665995 DOI: 10.1055/s-0042-1756628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are uncommon benign lesions that are rarely diagnosed radiographically. We report an unusual case of a left middle cerebellar peduncle CAPNON with vasogenic edema and a perilesional cyst. The patient was a 36-year-old woman with a 20-year history of left-sided hearing loss that had recently progressed. Computed tomography and magnetic resonance imaging showed a heterogenous calcified lesion with vasogenic edema and a perilesional cyst in the left middle cerebellar peduncle. Although it is a rare radiographic feature of CAPNON, vasogenic edema should be included as a possible feature of this uncommon tumefactive lesion.
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Affiliation(s)
- Austin Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jarom Gropp
- School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Vance L. Fredrickson
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Hediyeh Baradaran
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States,Address for correspondence William T. Couldwell, MD, PhD Department of Neurosurgery, Clinical Neurosciences Center, University of Utah175 N. Medical Drive East, Salt Lake City, UT 84132United States
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Li Y, Yang X, Liang Z, Zheng J, Zhou H, Li H. Giant calcified pseudoplasm of the nerve axis of the temporal lobe: a case report and review of the literature. Acta Neurol Belg 2021; 122:1477-1484. [PMID: 33675530 DOI: 10.1007/s13760-021-01641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 02/05/2023]
Abstract
Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are rare and can occur along the neural axis. The pathogenesis of these masses is still unknown, and they are diagnosed by histopathological analysis. We report the largest CAPNON in the temporal lobe reported to date and a review of the literature on all previously reported CAPNON cases located in the temporal lobe. According to the literature review, prior to 2020, the largest CAPNON in the temporal lobe that had ever been reported measured 30 × 30 × 20 mm (Mohapatra et al.). However, we report a larger temporal lobe CAPNON (45 × 35 × 35 mm) in a female patient admitted to our hospital. In addition, among 22 patients with CAPNONs aged from 6 to 62 years, 45.5% were female and 54.5% were male. A total of 72.8% of patients presented with seizures, 9.1% had pituitary dysfunction and 9.1% did not have symptoms. Of the cases in the patients with seizures, 83.2% were completely surgically resected, 5.6% were partially surgically resected, and one was treated medically; one patient refused treatment. Except for one patient who had multiple lesions, all patients who underwent surgery exhibited improved or the disappearance of symptoms of epilepsy. The patient in whom epilepsy resolved had undergone total resection. CAPNON is a rare benign lesion that occurs throughout the nervous system, and the pathogenesis remains unclear. Although the hardness of these lesions vary, surgery is still the preferred treatment and yields good results, and total resection is recommended for patients with epilepsy in the temporal lobe.
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Affiliation(s)
- Yujian Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zuoyu Liang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Huiqing Zhou
- Department of Intensive Care Unit, Fourth People's Hospital of Sichuan Province, Chengdu, People's Republic of China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China.
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Yang K, Reddy K, Chebib I, Hammond R, Lu JQ. Calcifying Pseudoneoplasm of the Neuraxis: From Pathogenesis to Diagnostic and Therapeutic Considerations. World Neurosurg 2021; 148:165-176. [PMID: 33508489 DOI: 10.1016/j.wneu.2021.01.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion that can develop anywhere within the neuraxis. The incidence is likely underreported, given its nonspecific imaging features and because CAPNON has often been overwhelmed by the presence of comorbid disease. CAPNON is typically diagnosed by the histopathological examination findings. However, the histopathological diagnosis is often challenging owing to the existence of similar calcifying pathological entities. Although the pathogenesis of CAPNON has remained elusive, emerging evidence supports a reactive proliferative and immune-mediated process involving the aggregation of neurofilament light chain protein and the infiltration of immune cells. The management of CAPNON is largely dependent on the symptoms, which are mainly related to the location and associated mass effects. Maximal surgical resection will result in excellent patient outcomes with rare recurrence, especially in patients presenting with epilepsy. The discovery of neurofilament light chain protein within CAPNON suggests that neurofilament might be implicated in the pathogenesis of CAPNON, serve as an immunohistochemical marker to improve the diagnostic accuracy of CAPNON, and hold therapeutic potential for the treatment of CAPNON.
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Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Kesava Reddy
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Neuropathology, McMaster University, Hamilton, Ontario, Canada.
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Lu JQ, Berthelet F, Bojanowski MW. Letter to the Editor Regarding "Case of Calcifying Pseudoneoplasms of the Neuraxis Coexisting with Interhemispheric Lipoma and Agenesis of the Corpus Callosum: Involvement of Infiltrating Macrophages". World Neurosurg 2020; 139:668-669. [PMID: 32689674 DOI: 10.1016/j.wneu.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Jian-Qiang Lu
- Neuropathology Section, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - France Berthelet
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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Inukai M, Shibahara I, Kumabe T. In Reply to the Letter to the Editor Regarding "A Case of Calcifying Pseudoneoplasms of the Neuraxis Coexisting with Interhemispheric Lipoma and Agenesis of the Corpus Callosum: Involvement of Infiltrating Macrophages". World Neurosurg 2020; 139:670-671. [PMID: 32689675 DOI: 10.1016/j.wneu.2020.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Madoka Inukai
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Immunohistochemical Markers in the Diagnosis of Calcifying Pseudoneoplasm of the Neuraxis. Can J Neurol Sci 2020; 48:259-266. [PMID: 32800010 DOI: 10.1017/cjn.2020.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unknown pathogenesis. It is likely under-reported due to diagnostic challenges including the nonspecific radiographic features, lack of diagnostic markers, and often asymptomatic nature of the lesions. METHODS We performed detailed examination of 11 CAPNON specimens diagnosed by histopathology, with the help of electron microscopy and immunohistochemistry. RESULTS Electron microscopy revealed the presence of fibrillary materials consistent with neurofilaments. In addition to some entrapped axons at the periphery of CAPNONs, we discovered that all specimens stained positive for neurofilament-light (NF-L) within the granular amorphous cores, but not neurofilament-phosphorylated (NF-p). CAPNONs also showed variable infiltration of CD8+ T-cells and a decreased ratio of CD4/CD8+ T-cells, suggesting an immune-mediated process in the pathogenesis of CAPNON. CONCLUSION NF-L and CD4/CD8 immunostains may serve as diagnostic markers for CAPNON and shed light on its pathogenesis.
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Huang J, Ghent F, Rodriguez M, Davies M. Calcifying pseudoneoplasm of the neuraxis: A rare case involving the oculomotor nerve. Surg Neurol Int 2020; 11:249. [PMID: 32905291 PMCID: PMC7468187 DOI: 10.25259/sni_386_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare entity which can occur at intracranial and spinal locations. Clinical presentation is due to local mass effect rather than tissue infiltration. Lesions causing significant symptoms or are showing radiological progression require surgical resection. Maximal surgical resection is considered curative for this non-neoplastic entity with only two cases of recurrence reported in the literature. Cranial nerve involvement is extremely rare and the presenting neurological deficit is unlikely to improve even with surgical intervention. Case Description: We describe a case of CAPNON at the right posterior clinoid process with involvement of the right oculomotor nerve in a 38-year-old male. Computed tomography demonstrated an amorphous mass which had intermediate to low T1 and T2 signal on magnetic resonance imaging. The oculomotor nerve was compressed with sign of atrophy. The patient underwent maximal surgical debulking for progressive symptoms of worsening pain and ophthalmoplegia. Postoperatively, the patient’s symptoms were stable but did not improve. Conclusion: Preoperative diagnosis of CAPNON is difficult due to its rarity and nonspecific clinical and radiological findings. Surgical resection is considered in cases with worsening symptoms, progression on serial imaging, or uncertain diagnosis. Relatively inaccessible lesions with little or no clinical symptoms can be observed.
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Affiliation(s)
- Jiahua Huang
- Department of Neurosurgery, St George Public Hospital, Gray Street, Australia
| | - Finn Ghent
- Department of Neurosurgery, St George Public Hospital, Gray Street, Australia
| | - Michael Rodriguez
- Department of Kogarah, Pathology, Douglass Hanly Moir Pathology, Macquarie Medical Centre, Macquarie Park, New South Wales, Australia
| | - Mark Davies
- Department of Neurosurgery, St George Public Hospital, Gray Street, Australia
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Lu JQ, Popovic S, Provias J, Cenic A. Collision Lesions of Calcifying Pseudoneoplasm of the Neuraxis and Rheumatoid Nodules: A Case Report With New Pathogenic Insights. Int J Surg Pathol 2020; 29:314-320. [PMID: 32666850 DOI: 10.1177/1066896920941939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unclear pathogenesis. Collision lesions of CAPNONs with neoplasms are occasionally reported. In this article, we report the first case of collision lesions between CAPNON and rheumatoid nodules (RNs) in a patient with systemic lupus erythematosus. The patient was a 51-year-old female who presented with lower back pain and subsequently a lower back mass over 2 years. Spinal magnetic resonance imaging demonstrated a heterogeneous, partially calcified mass centered in the L3-4 paravertebral regions. A biopsy of the mass was diagnostic of CAPNON. As the mass grew over the following 5 months, it was resected en bloc. Its pathological examination revealed collision lesions of RNs at different histopathological stages and CAPNON lesions, and transitional lesions exhibiting combined RN and CAPNON features, with immune cell infiltrates. Our findings provide new evidence for an immune-mediated reactive process and insights into the pathogenies of CAPNON.
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Affiliation(s)
| | | | - John Provias
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Aleksa Cenic
- 3710McMaster University, Hamilton, Ontario, Canada
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