Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 8, 2016
Psammomatous Meningioma
- Background:
- Spinal meningiomas represent 20–25% of all primary spine tumors (intradural compartment: 83–94%). They are more frequent in females between the fifth and seventh decades of life.
- The psammomatous variant is the most common subtype in the spinal cord.
- These tumors are marked by “abundant psammoma bodies,” which may become confluent and form calcified masses.
- Treatment of choice is complete tumor resection, and the overall prognosis will depend on the extent of the resection. Risk factors for postoperative recurrence are young age, multiple lesions, and calcifications.
- Clinical Presentation:
- Usually, pain and weakness for several months
- Key Diagnostic Features:
- Intradural extramedullary lesion surrounding the spinal cord with homogeneous enhancement. Calcification occurs in less than 5% of patients.
- Differential Diagnosis:
- Inflammatory pseudotumor (IgG-4 disease): Increased serum IgG-4 levels. May be indistinguishable based on imaging only.
- Meningeal carcinomatosis: Diffuse enhancement of the leptomeninges, called "sugar coating" or zuckerguss, as well as the nerve roots.
- Lymphoma: T2WI and ADC show relative hypointensity due to the hypercellularity. May have multicompartimental involvement, including bone infiltration
- Hemangioma: High signal intensity on T2 images; avid, slightly heterogeneous enhancement
- Mesenchymal neoplasia: May be indistinguishable based con imaging alone.
- Treatment:
- Surgical resection. Tailored radiotherapy. Follow-up. Treatment decisions will be based on the severity of the myelopathic symptoms.
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