Clinical characteristics and surgical outcomes of primary spinal paragangliomas

Primary Intraosseous Paraganglioma of the Femoral Neck: A Case Report and Review of the Literature

CASE

An 88-year-old woman presented with worsening right hip pain over 2 years. Radiographs were unremarkable, but magnetic resonance imaging identified a femoral neck lesion. A computed tomography-guided biopsy revealed a zellballen pattern of cells positive for chromogranin and synaptophysin. Further workup, including a metaiodobenzylguanidine scan confirmed focal uptake at the right femoral neck. After multidisciplinary discussion, and shared decision-making with the patient, conservative management was chosen.

CONCLUSION

Primary intraosseous paragangliomas are rare, with this case representing only the second reported in femur and third in the appendicular skeleton. It underscores the importance of a multimodal diagnostic approach, individualized treatment plans, and multidisciplinary collaboration.

Cauda equina neuroendocrine tumor: a report of three cases and review of the literature with focus on differential diagnosis and postoperative management

INTRODUCTION

Cauda equina neuroendocrine tumors (CENETs), previously described as cauda equina paragangliomas (PGLs) are rare and well-vascularized benign entities which can be often misdiagnosed with other intradural tumors more common in this anatomical site, such as ependymomas and neurinomas. We describe three cases of CENETs observed at our institution with particular focus on differential diagnosis and postoperative management. Since the lack of guidelines, we performed a literature review to identify factors that can predict recurrence and influence postoperative decision making.

CASE REPORT AND LITERATURE REVIEW

We report on three patients, two of them presenting with a clinical history of lower back pain and sciatica. In all cases magnetic resonance imaging (MRI) of the lumbosacral spine with and without Gd-DTPA revealed an intradural lesion with strong contrast enhancement, first described as atypical ependymoma or schwannoma. A complete tumor resection was achieved in all cases, the histopathological diagnosis classified the tumors as CENETs. In our literature review, a total of 688 articles were screened and 162 patients were included. Patients demographic data, clinical symptoms, resection and recurrence were recorded.

DISCUSSION

Differential diagnosis between CENETs and other more common tumors affecting cauda equina region, such as ependymomas or schwannomas (neurinomas), is still very challenging. Due to the lack of specific clinical or radiological characteristics, a correct preoperative diagnosis is almost impossible. With this paper we want to point out that CENETs must be considered in the differential diagnosis, most of all in case of entities with atypical radiological features. According to the literature, tumor recurrence after gross total resection is unlikely, while a long-term follow-up is recommended in case of subtotal resection or local aggressive behavior.

A case of rare lumbar intradural tumor: paraganglioma

Lumbar paragangliomas are rare neuroendocrine neoplasms arising from specialized neural crest cells in the cauda equina/filum terminale region. They are difficult to diagnose radiologically and can be difficult to treat surgically if they secrete catecholamines. A 38-year-old woman presented with three and a half years of increasing lower back and sacrum discomfort. Her neurological examination was normal. The MRI revealed an L4 intradural lesion that was compressing the cauda equina. A total tumor resection was conducted. The paraganglioma was diagnosed by the pathology report. Paragangliomas should be considered in the differential diagnosis of intradural masses of the lumbar spine.

Cauda equina neuroendocrine tumors: A single institutional imaging review of cases over two decades

Cauda Equina Neuroendocrine Tumors (CE-NET), previously referred to as paragangliomas are a rare subset of spinal tumors, with limited data on imaging. Herein, we present a retrospective review of clinical and imaging findings of CE-NETs in ten patients who were evaluated at our institution over the past two decades. All patients had well-defined intradural lesions in the lumbar spine which demonstrated slow growth. A review of imaging findings revealed the presence of an eccentric vascular pedicle along the dorsal aspect of the tumor in 8 of the 10 patients (eccentric vessel sign), a distinctive finding that has not previously been reported with this tumor and may help improve the accuracy of imaging-based diagnosis. In all cases, a gross-total resection was performed, with resolution of symptoms in most of the cases.

Does the degree of preoperative gait disturbance remain after tumor resection in patients with intradural extramedullary spinal cord tumors?

STUDY DESIGN

Retrospective comparative study.

OBJECTIVE

This study aimed to determine whether the degree of preoperative gait disturbance remains following surgical resection in patients with intradural extramedullary spinal cord tumors (IDEMSCTs), and to investigate any factors that may influence poor improvement in postoperative gait disturbance.

SETTING

The single institution in Japan.

METHODS

In total, 78 IDEMSCTs patients who required surgical excision between 2010 and 2019 were included. According to the degree of preoperative gait disturbance using modified McCormick scale (MMCS) grade, they were divided into the Mild and Severe groups. The mean postoperative follow-up period was 50.7 ± 17.9 months. Data on demographic and surgical characteristics were compared between the two groups.

RESULTS

There was no significant difference in terms of age at surgery, sex, tumor size, surgical time, estimated blood loss, tumor histopathology, and postoperative follow-up period between the Mild and Severe groups. At the final follow-up, 84.6% of IDEMSCTs patients were able to walk without support. Gait disturbance improved after surgery in most of the patients with preoperative MMCS grades II-IV, but remained in approximately half of patients with preoperative MMCS grade V. Age at surgery was correlated with poor improvement in postoperative gait disturbance in the Severe group.

CONCLUSIONS

Regardless of the degree of preoperative gait disturbance, it improved after tumor resection in most of the IDEMSCTs patients. However, in the preoperative MMCS grade III-V cases, older age at surgery would be an important factor associated with poor improvement in postoperative gait disturbance.

Cauda Equina Neuroendocrine Tumor: A Histopathological Case Report

Cauda equina neuroendocrine tumors (CENET) are rare neoplastic processes that develop in the cauda equina or filum terminale region of the spinal cord, which in previous incarnations of the World Health Organization (WHO) classification of the central nervous system (CNS) tumors were designated as paragangliomas. The change of terminology was carried out due to the rarity of the condition, its specific place of origin, the non-specific clinical and imaging characteristics with which the tumors present, and differences in biological properties (secretion and progression) as well as some minor differences in immunohistochemical protein expression patterns. Herein, we present a case of a male patient in his sixties who presented to us for a histopathological consultation of a previously excised tumor, which was grossly well-demarcated and connected to a nerve root in the cauda equina region. The tumor presented with histomorphological features of a sharply demarcated, non-infiltrative tumor growing in a nested to pseudopapillary pattern with a highly vascularized, intersecting stroma. Tumor cells were mildly atypical ovoid ones, with eosinophilic cytoplasm, central hyperchromatic nuclei, some with nucleoli, and salt and pepper chromatin. Intersecting stroma was rich in reticulin fibers, and the cell did not express epithelial membrane antigen, excluding the diagnosis of ependymoma as well as glial markers, excluding glial origin. Pan-cytokeratin was focally positive, neuroendocrine markers were diffusely positive, and the proliferative index was low. As such, the diagnosis of CENET, WHO CNS grade 1 was established, and the patient was referred back to the institution at which the surgery was performed for follow-up and further management.

Tadpole Sign in Filum Terminale Paragangliomas

Two normotensive male patients came with complaints of low back pain. Contrast-enhanced magnetic resonance imaging of the lumbosacral spine revealed an enhancing intradural extramedullary lesion (at the L4-L5 vertebral level in the first patient and at the L2-L3 vertebral level in the second patient). The tumor resembled the head and caudal blood vessels the tail of a tadpole, thereby giving the "tadpole sign." This sign is an important radiologic and histopathologic correlate, which is helpful in preoperative diagnosis of spinal paraganglioma.

Case Report: Paraganglioma in the sellar region: longitudinal observation and surgical outcome

Background

Paraganglioma in the sellar region is an extremely rare entity, with a limited number of cases reported in the literature. Due to the paucity of clinical evidence, the diagnosis and treatment of paragangliomas in the sellar region remain challenging. Herein, we reported a case of sellar paraganglioma with parasellar and suprasellar extension. Particularly, the dynamic evolution of this benign tumor within a 7-year longitudinal observation was presented. Additionally, the relevant literature regarding sellar paraganglioma was comprehensively reviewed.

Case description

A 70-year-old woman presented with progressive visual deterioration and headache. Brain magnetic resonance imaging demonstrated a mass in the sellar region with parasellar and suprasellar extension. The patient refused surgical treatment. Seven years later, brain magnetic resonance imaging showed the lesion significantly progressed. Neurological examination revealed bilateral tubular contraction of visual fields. Laboratory examinations showed endocrine hormone levels were normal. Surgical decompression was performed via a subfrontal approach, and subtotal resection was achieved. Histopathological examination confirmed a diagnosis of paraganglioma. Postoperatively, she developed hydrocephalus, and ventriculoperitoneal shunting was performed. Eight months later, cranial CT showed no recurrence of the residual tumor, and the hydrocephalus had been relieved.

Conclusion

Paraganglioma occurring in the sellar region is rare, and the preoperative differential diagnosis is difficult. Owing to the infiltration to the cavernous sinus and internal carotid, complete surgical resection is usually impracticable. There has been no consensus regarding postoperative adjuvant radiochemotherapy for the tumor residue. In-situ recurrence and metastasis have been reported in the literature, and close follow-up is warranted.

Primary Paraganglioma of the Spine: A Systematic Review of Clinical Features and Surgical Management in Cauda Equina vs Non-Cauda Equina Lesions

BACKGROUND

Primary spine paragangliomas are rare tumors. Surgical resection plays a role, but aggressive lesions are challenging. We reviewed the literature on primary spine paragangliomas.

METHODS

PubMed, Scopus, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies on primary spine paragangliomas. Clinical-radiological features, treatments, and outcomes were analyzed and compared between cauda-equina vs non-cauda-equina tumors.

RESULTS

We included 143 studies comprising 334 patients. Median age was 46 years (range, 6-85). The most frequent symptoms were lower-back (64.1%) and radicular (53.9%) pain, and sympathetic in 18 patients (5.4%). Cauda-equina paragangliomas (84.1%) had frequently lumbar (49.1%) or lumbosacral (29%) locations. Non-cauda-equina tumors were mostly in the thoracic (11.4%), thoracolumbar (5.1%), and cervical (3.6%) spine. Median tumor diameter was 2.5cm (range, 0.5-13.0). Surgical resection (98.5%) was preferred over biopsy (1.5%). Decompressive laminectomy (53%) and spine fusion (6.9%) were also performed. Adjuvant radiotherapy was delivered in 39 patients (11.7%) with aggressive tumors. Post-treatment symptomatic improvement was described in 86.2% cases. Median follow-up was 19.5 months (range, 0.1-468.0), and 23 patients (3.9%) had tumor recurrences. No significant differences were found between cauda-equina vs non-cauda-equina tumors.

CONCLUSION

Surgical resection is effective and safe in treating primary spine paragangliomas; however, adjuvant treatments may be needed for aggressive lesions.

Paraganglioma of the filum terminal: Case report and review of the literature

Paraganglioma of the filum terminal/cauda equina is a rare slow growing tumor which originates from the ectopic sympathetic neurons. Surgically, total excision may be difficult for this well demarcated tumor surrounded by couple of rootlets but is usually possible in nearly all cases. Actually, final diagnosis cannot be determined intraoperatively, but is possible only after an immunohistochemical staining. Herein, the authors present a middle age woman whose initial symptoms were lower back pain and radiculopathy. Her MRI was found to be compatible with a cauda equina tumor. During her excisional surgery a hard and relatively vascular tumor was fully removed. The Immunohistochemical results were compatible with paraganglioma of the filum terminale. In addition to case presentation, thorough review of the literature is also done.

Autopsy of malignant paraganglioma causing compressive myelopathy due to vertebral metastases

Paraganglioma is a neuroendocrine tumor arising from extra-adrenal sites in the peripheral nervous system. Although malignant paraganglioma is known to metastasize to bones, including vertebral bodies, there is little literature on the compressive myelopathy accompanied by sphincter dysfunction; to our knowledge, only 12 cases have been reported. Moreover, neuropathological investigations of the spinal cord in this state have not been well-documented. This autopsy report describes a 55-year-old man with malignant paraganglioma and compression myelopathy caused by vertebral metastasis. The present case showed a gradual numbness and a sudden onset of irreversible paraplegia with sphincter dysfunction, which were not palliated these neurologic dysfunctions despite radiotherapy. Computed tomography (CT) revealed multiple metastases to the bones, lymph nodes, and lungs when he was diagnosed with malignant paraganglioma. At the same time, he had numbness, and magnetic resonance imaging (MRI) showed multiple diffuse metastatic lesions in the vertebral bodies. Following abrupt onset of paralysis, MRI showed fractured third and sixth thoracic vertebral bodies. An autopsy revealed residual vertebral metastases with fractures of the third and sixth thoracic vertebral bodies, resulting in compressive myelopathy at the fourth thoracic segment, which was characterized by complete spinal cord destruction. Destructive spinal cord lesion-induced secondary degeneration was observed in the gracile fasciculus at the rostral side and in the pyramidal tract at the caudal side, which showed Wallerian degeneration. Such pathology was consistent with the presenting neurological symptoms, including paraplegia and somatic sensory loss below the fourth thoracic spinal cord segment. Although it is difficult to identify the pathognomonic morphological changes responsible for the sphincter dysfunction, the present case suggests a supranuclear dysregulation of the somatosensory and central autonomic nervous systems involved in urination and defecation. Based on a review of the literature and the features of the present case, paraganglioma can metastasize aggressively even with a low pathological grading. This case of vertebral metastasis as a result of malignant paraganglioma may not be extraordinary but the autopsy report is rare. This autopsy revealed transverse myelopathy as a result of malignant vertebral metastasis of malignant paraganglioma.

Primary Lumbar Paraganglioma: Clinical, Radiologic, Surgical, and Histopathologic Characteristics from a Case Series of 13 Patients

BACKGROUND

Paragangliomas are uncommon neuroendocrine tumors, rarely occurring in the lumbar spine. Primary lumbar paragangliomas are prominently vascularized, can present variably, and pose both diagnostic and surgical challenges. We report on a large case series with long-term follow-up and intraoperative footage to characterize the natural history, diagnostic approach, and operative approach to this rare surgical disease.

METHODS

This is a single-center, retrospective cohort study including all patients with histologically confirmed primary lumbar paraganglioma treated at our tertiary neurosurgical center between 1997 and 2018. Clinical, radiologic, surgical, and histologic data were collected from medical records.

RESULTS

There were 13 cases of primary lumbar paraganglioma (8 men [61.5%], 5 women [38.5%]; mean age, 51.3 years; range, 33.2-68.9 years). Symptom duration correlated with tumor size (Spearman r = 0.735, P = 0.01). The main presenting symptoms were lower back pain and radiculopathy, often long-standing with recent deterioration. Seven patients (53.8%) were admitted as emergency cases, including 3 with cauda equina syndrome. Preoperative differential diagnoses included nerve sheath tumor, ependymoma, meningioma, and disk herniation. The mean Ki-67 mitotic index was 5.7% (range, 1%-10%). Surgical resection improved pain in 8 of 13 patients (61.5%) and weakness improved in 5 of 5 patients (100%).

CONCLUSIONS

Primary lumbar paragangliomas are rare neoplasms of the cauda equina that typically progress slowly but may also present acutely. They are often related to the filum terminale, which should be resected prior to other attachments intraoperatively to prevent displacement of the tumor out of view. Total resection can be curative, and long-term follow-up in this series found no recurrence.

Locally invasive giant spinal paraganglioma

Cauda equina paragangliomas are neuroendocrine tumours rarely encountered in neurosurgical practice. Large cauda equina paragangliomas with an intradural and extradural component, dense adhesion to nerve roots and high vascularity are surgically challenging and mandate meticulous operative dissection. The presence of extensive bony erosion can lead to spinal instability requiring solid instrumentation and fixation. We recommend resection of large cauda equina paragangliomas in a staged fashion with the aim of gross total resection and spinal stabilisation.

[Paraganglioma of the cauda equina region: Report of 9 cases]

INTRODUCTION

The paraganglioma of the cauda equina is a rare tumor, the diagnosis is morphological and the immunohistochemistry provides a definite diagnosis. The objective of our study is to specify the clinical signs, radiological and associated pathological criteria and to compare our data with those of the literature.

PATIENTS AND METHOD

This is a retrospective study of nine cases of paragangliomas of the cauda equina diagnosed in our department from 2003 to 2018. The median age of the patients was 50 years-old with a male predominance (sex ratio: 3,5/1). All patients had preoperative magnetic resonance imaging (MRI) and surgery to remove the tumor. The diagnosis was performed after HES (Hematoxylin Eosin Saffron) and immunohistochemical sections examination.

RESULTS

Radiculalgia was the chief symptom of these tumors. MRI showed an oval lesion uniformly enhanced by Gadolinium in the eight patients whose records were available. Histologically, the tumors had a lobular and trabecular pattern with neuroendocrine-like cells and a rich vascularization. By immunohistochemistry, the cells expressed chromogranin, synaptophysin and CD56.

DISCUSSION AND CONCLUSION

Paragangliomas of the cauda equina are rare, benign tumors. Except for cases of secreting tumors, the preoperative diagnosis is difficult. MRI is useful and may reveal radiological features suggestive of these tumors. However, it is rare for the diagnosis to be made before surgery. The diagnosis is established by histological examination and immunohistochemical techniques must be used to confirm the diagnosis. The paragangliomas of the cauda equina are well encapsulated tumors whose complete excision is curative. When the excision is incomplete, treatment with radiotherapy is recommended. Long-term clinical and radiological monitoring is recommended because of the slow evolution of the tumor and the potential for recurrence.

Paraganglioma of the cauda equina: MR and angiographic findings

Paragangliomas of the cauda equina are rare benign highly vascular tumors and occur almost exclusively in the cauda equina and filum terminale of the spinal cord. We present a case spinal paraganglioma of the cauda equina in a 75-year-old male with an emphasis on magnetic resonance imaging and conventional angiography findings.

Paraganglioma of the Lumbar Spine: A case report and literature review

INTRODUCTION

Lumbar paragangliomas are rare, vascular, neuroendocrine tumors. They are notoriously difficult to diagnose radiologically and can prove challenging to manage intraoperatively, if capable of catecholamine secretion.

CASE REPORT

We report the case of a 45-year-old man, who presented with a lumbar spinal paraganglioma. The patient described a 2-year history of worsening lower back pain and sciatica. Neurological examination was normal. MRI revealed a lesion at L3, with prominent vessels, compressing the cauda equina. Gross total resection (GTR) of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit.

DISCUSSION

A literature search of lumbar paraganglioma cases, from January 1970 to April 2018 was carried out. Results of this review highlighted the importance of inclusion of paraganglioma as a differential diagnosis in lumbar spinal tumor and also the requirement for preoperative investigations to determine any potential secretory activity.

CONCLUSIONS

Lumbar paraganglioma behavior is most commonly benign and rates of recurrence are low after GTR. However, long-term postoperative follow-up is crucial, due to findings of late metastatic recurrence.

Spinal paragangliomas: Surgical treatment and follow-up outcomes in eight cases

Paragangliomas are neuro-endocrine tumors originating from the adrenal gland. They are usually benign and nonfunctioning, rarely seen in central nervous system. More than 90% of central nervous system paragangliomas are manifested as carotid and glomus jugulare tumors. Spinal paragangliomas are quite rare.The study was conducted through retrospective analysis of the files of the patients who had undergone surgery with pre-diagnosis of spinal intradural tumor between 2011 and 2017 and diagnosed with paraganglioma.A total of 8 patients (4 females and 4 males) were included in the study. Mean age of the patients was 51.1 years (28-64). Time to admission was mean 6.5 months (3 weeks-24 months). Recurrence was not observed in 7 patients, 1 patient is being followed up due to residual tumor.Treatment may be achieved through recognizing malignant transformation in patients who were not diagnosed histopathologically. We consider that quality of life of the patients may be improved through this way.

Successful treatment of malignant pheochromocytoma with sacrum metastases: A case report

RATIONALE

Malignant pheochromocytoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of malignant pheochromocytoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with three operations combined with cement augmentation and stabilization. The management of these unique cases has yet to be well-documented.

PATIENT CONCERNS

A 58-year-old man presented with lumbosacral pain, radiating pain and numbness of the right extremity. The patient underwent excision of right adrenal pheochromocytoma in 2010. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction.

DIAGNOSES

We believe this is the first report of malignant pheochromocytoma with sacrum metastases.

INTERVENTIONS

The patient underwent tissue biopsy and osteoplasty after embolization of the internal iliac artery in January 2015, and exploratory surgery, circumferential spinal cord decompression, and a stabilization procedure via a posterior approach in June 2015 due to spinal canal stenosis caused by cement. Since the position of pedicle screw was not good enough, a revision surgery was performed the next day following the procedures in June 2015.

OUTCOMES

The patient's neurological deficits improved significantly after the third surgery, and the postoperative period was uneventful at the three-year follow-up visit.

LESSONS

We recommend the posterior approach for spinal decompression of the metastatic pheochromocytoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment. However, the potential risk of complications in bone cement applications need to be fully recognized.

Primary extradural paraganglioma of the thoracic spine: A case report

Paragangliomas are rare, mostly benign neuroendocrine tumors arising from autonomic paraganglia. Spinal paragangliomas are uncommon, and among these, paragangliomas of the thoracic spine are distinctly unusual. We present the case of a primary paraganglioma of the extradural thoracic spine in a 34-year-old woman.

Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: Literature review with one case report

RATIONALE

We present a rare case of malignant pheochromocytoma with thoracic metastases during pregnancy that presented with symptoms of myelopathy and was treated with circumferential decompression, stabilization, and radiation. The management of this unique case is not well documented. The clinical manifestations, imaging results, pathological characteristics, treatment and prognosis of the case were analyzed.

PATIENT CONCERNS

A 26-year-old pregnant woman with a history of paroxysmal hypertension during the second trimester presented with lower extremity weakness, numbness, urinary incontinence, and back pain. Imaging studies revealed a right adrenal pheochromocytoma, multiple metastases at T8, T11, T12, and the pelvis girdle causing significant multilevel cord compression and significant osteolytic lesions at T11 and T12.

DIAGNOSES

We believe this is the first reported case of metastatic pheochromocytoma of the thoracic spine presenting with symptoms of myelopathy during pregnancy.

INTERVENTIONS

A healthy neonate was delivered by emergency caesarean section at 34 weeks. Subsequently, the patient underwent a circumferential spinal cord decompression and a stabilization procedure.

OUTCOMES

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month follow-up visit.

LESSONS

This article emphasizes that metastatic pheochromocytoma of the spine, although rare, should be part of the differential when a patient presents with elevated blood pressure, weakness, and urinary incontinence.

Acute onset of paraganglioma of filum terminale: A case report and surgical treatment

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A very rare case of paraganglioma of filum terminale is described.

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Clinical and radiological features of spinal paraganglioma are listed.

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Surgical management of paraganglioma of filum terminale is discussed.

Introduction

Paragangliomas of filum terminale are rare benign tumors, arising from the adrenal medulla or extra-adrenal paraganglia. These lesions usually present with chronic back pain and radiculopathy and only two cases of acute neurological deficit have been reported in literature.

Presentation of case

A case with an acute paraplegia and cauda equina syndrome due to an hemorrhagic paraganglioma of the filum terminale is described. Magnetic resonance imaging showed an intradural tumor extending from L1 to L2 compressing the cauda equina, with an intralesional and intradural bleed. An emergent laminectomy with total removal of the tumor was performed allowing a post-operative partial sensory recovery. Histopathological examination diagnosed paraganglioma.

Discussion

Paragangliomas are solid, slow growing tumors arising from specialized neural crest cells, mostly occurring in the head and neck and rarely in cauda equina or filum terminale. MRI is gold standard radiological for diagnosis and follow-up of these lesions. They have no pathognomonic radiological and clinical features and are frequently misdiagnosed as other spinal lesions. No significant correlation was observed between the duration of symptoms and tumor dimension. Acute presentation is unusual and emergent surgical treatment is fondamental. The outcome is very good after complete excision and radiotherapical treatment is recommended after an incomplete resection. Conclusion: Early radiological assessment and timely surgery are mandatory to avoid progressive neurological deficits in case of acute clinical manifestation of paraganglioma of filum terminale.

Clinical characteristics and surgical treatment of spinal paraganglioma: A case series of 18 patients

BACKGROUND AND OBJECTIVES

Paraganglioma rarely develops in the spine. With few cases reported, little knowledge about this disease was known. The objective of this study is to illustrate the clinical features, imaging manifestations, pathological appearances and long-term outcomes of the consecutive surgeries by literature review.

METHODS

The clinical and follow-up data of 18 patients who were diagnosed of spinal paraganglioma and treated with surgeries in our hospitals from 2003 to 2014 were retrospectively analyzed.

RESULT

A total of fourteen patients radiographed of intra-spinal tumor underwent extra-capsular tumor resection. Of five patients with obvious vertebral bone damage, four cases underwent piecemeal resection, and the left one with sacral tumor underwent en bloc tumor excision. Spinal reconstruction was performed in all cases. Follow-up lasted for 16-96 months (44.1 months on average). There was no local recurrence or distant metastasis in cases without obvious bone invasion. Of those five cases with vertebral bone damage, one case suffered and survived from the repeat relapse of T1 vertebral body tumor. Local recurrence was not observed in one case with T10 vertebral tumor after tumor resection, but the tumor metastasized to T2 attachment during the follow-up and was finally eradicated by re-operation. No tumor recurrence was observed in the left three cases.

CONCLUSION

Paraganglioma, usually benign, rarely occurs. Surgical resection, especially complete surgical resection, is preferred to treat spinal paraganglioma. Chemotherapy, radiotherapy, use of octreotide and other somatostatin are selected as adjuvant therapies, but their effects remain unknown.

Successful treatment of metastatic pheochromocytoma in the spine with cement augmentation

Metastatic pheochromocytoma in the spine is rare, and there is no standard curative management. Treatment via open surgery is often risky in the perioperative period, while osteoplasty by cement augmentation is a less invasive option.We describe 2 patients with recurrence of pheochromocytoma involving the spine and the pelvis who were successfully treated with osteoplasty by cement augmentation. A 31-year-old female underwent cement augmentation for a pelvic lesion 6 months after the resection and screw fixation of an L3 lesion. A 58-year-old male underwent cement augmentation to directly destroy the functional tumor, with a surgical decompression 6 months later. Both patients showed appropriate destruction of the tumor, adequate pain relief, and the decreased release of catecholamine from metastatic lesions.Osteoplasty by cement augmentation may be a treatment option for patients with metastatic pheochromocytoma who cannot undergo appropriate surgery or decline surgery. This represents a safe approach to sustainably relieve pain and stabilize vertebral bodies with metastatic malignant pheochromocytoma.

Paraganglioma of the Filum Terminale: Case Report, Pathology and Review of the Literature

Spinal paragangliomas are very rare neuroendocrine tumors often presenting with low back pain and radicular symptoms; once resected, they often show benign clinical outcomes. Radiographically spinal paragangliomas mimic more commonly described tumors, such as ependymomas, schwannomas, meningiomas, and even hemangiomas, but a “salt and pepper” appearance related to a serpiginous vascular structure is instructive. Indeed, the rarity of this tumor makes the diagnosis rather challenging radiographically. Graded as a WHO Grade I tumor, they are slow-growing with low proliferation indices. Gross total resection is the mainstay of operative treatment but is often limited by tumor adherence to functional nerves. Here, we present a case of this rare tumor and its management, including a review of the pathology and literature related to this tumor.