Extradural nodular fasciitis arising in the spinal canal

Concomitant spinal dural arteriovenous fistula and nodular fasciitis in an adolescent: case report

Background

Spinal dural arteriovenous fistula (SDAVF) usually occurs during the 4^th to 6^th decades of life, and adolescent SDAVF is rarely reported. SDAVF arising around a tumor is also rare, and reported tumors are mostly schwannoma and lipoma.

Case presentation

We reported a 16-year-old male presented with progressive weakness and numbness of lower limbs for 3 months. A SDAVF was found, which was fed by right radicular arteries from segmental artery at L2 level and drained retrogradely into perimedullary veins. A concomitant spinal extradural nodular fasciitis at right L1/L2 intervertebral foramen was also noted. The SDAVF was completely obliterated by endovascular treatment and the tumor was debulked. The patient recovered well after the procedures.

Conclusions

Our case report suggests SDAVF can occur in adolescent. The concomitant presence with a nodular fasciitis indicates that although it usually arises in subcutaneous tissue but can rarely form on the dura of spine.

Primary extradural tumors of the spinal column: A comprehensive treatment guide for the spine surgeon based on the 5th Edition of the World Health Organization bone and soft-tissue tumor classification

BACKGROUND

In 2020, the World Health Organization (WHO) published the 5th version of the soft tissue and bone tumor classification. Based on this novel classification system, we reviewed the current knowledge on all tumor entities with spinal manifestations, their biologic behavior, and most importantly the appropriate treatment options as well as surgical approaches.

METHODS

All tumor entities were extracted from the WHO Soft-Tissue and Bone Tumor Classification (5th Edition). PubMed and Google Scholar were searched for the published cases of spinal tumor manifestations for each entity, and the following characteristics were extracted: Growth pattern, ability to metastasize, peak age, incidence, treatment, type of surgical resection indicated, recurrence rate, risk factors, 5-year survival rate, key molecular or genetic alterations, and possible associated tumor syndromes. Surgical treatment strategies as well as nonsurgical treatment recommendations are presented based on the biologic behavior of each lesion.

RESULTS

Out of 163 primary tumor entities of bone and soft tissue, 92 lesions have been reported along the spinal axis. Of these 92 entities, 54 have the potential to metastasize. The peak age ranges from conatal lesions to 72 years. For each tumor entity, we present recommended surgical treatment strategies based on the ability to locally destruct tissue, to grow, recur after resection, undergo malignant transformation as well as survival rates. In addition, potential systemic treatment recommendations for each tumor entity are outlined.

CONCLUSION

Based on the 5th Edition of the WHO bone and soft tumor classification, we identified 92 out of 163 tumor entities, which potentially can have spinal manifestations. Exact preoperative tissue diagnosis and interdisciplinary case discussions are crucial. Surgical resection is indicated in a significant subset of patients and has to be tailored to the specific biologic behavior of the targeted tumor entity based on the considerations outlined in detail in this article.

Nodular Fasciitis: Sonographic-Pathologic Correlation

We evaluated nodular fasciitis (NF) in 19 patients, focusing on the correlation between its sonographic and histopathologic features. Sonograms were retrospectively reviewed, and the location, shape, margin, echogenicity, echogenic rim, peripheral hyper-echoic nodules, posterior enhancement and vascularity of the lesions were recorded. In the histopathologic analysis, three patterns-infiltrating, pushing border and well circumscribed-were identified, and culture-like tissue centers were classified according to the distribution of focal keloid-like collagen bundles: uneven or even. For the sonographic-pathologic correlation, most NF cases were inhomogeneously hypo-echoic and had an echogenic rim, with an infiltrating or pushing border pattern. In addition, all NF cases with the infiltrating pattern were observed to have peripheral hyper-echoic nodules in sonograms. Thus, echogenic rims may be associated with the peripheral adipose tissues in infiltrating pattern, and the degree of infiltration may be associated with specific sonographic features of NF.