Pathology of Spinal Cord Tumors:

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Pathology of Spinal Cord Tumors

• Dr. Venkatesh Murthy Shashidhar
• Associate Professor of Pathology

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Introduction

• Uncommon significant morbidity
• Epidural intradural
• Intramedullary / Extramedullary

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Spinal Cord Tumors - WHO

• Metastatic tumors common. (ca, myeloma)
• Glial tumors glioma (children)
• Schwannoma (neurinoma, neurilemoma)
• cellular, plexiform, and melanotic subtypes
• Neurofibroma.
• circumscribed (solitary)/plexiform.
• Malignant schwannoma. (MPNST)
• Epithelioid, mesenchymal, melanotic or mix.
• Tumors of Meninges meningioma.
• Paraganglioma, Chordoma, Chondroma.

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Spinal cord metastasis-Prostate

• cervical spine
• Metastasis of prostate ca
• Gradient-echo sagittal MRI.
• Multiple high and low signal intensity
• C5 vertebral body collapse.
• Minimal cord deformity (arrowhead).

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Neurofibroma

• Endoneurial fibroblasts.
• Form whorls of fibroblasts
• Well differentiated, benign,
• No capsule, nerve enlarge surgery.
• Two types
• Classic form - Cutaneous / nerve - Solitary
  collagen matrix, spindle cells,
• Plexiform - Multiple, infiltrative, myxoid.

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Schwannoma

• Benign, adults, neck.
• Schwann cells, form whorls
• Nuclear palisading
• Antoni A B pattern, Verocay bodies.
• Bilateral of - 8th nerve - NF-2.

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Schwannoma
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Neurilemmoma
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Schwannoma/Acoustic neuroma
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Schwannoma
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Antony A - Antony B
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Antony B
Antony A
Palisades
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Schwannoma Cerebellum
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Neurofibromatosis

• Type I (common)(AD, 17q, 13000)
• Plexiform solitary neurofibromas
• Optic nerve gliomas, Lisch nodules, Café au lait
  spots.
• Type II (rare)(22q, 140,000)
• Bilateral acoustic schwannoma/osis
• Multiple meningioma/osis, ependymoma of spinal
  cord

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Phakomatosis (Neurocut. dysplasia)

• Neurologic abnormalities defects of skin or
  retina (ectodermal).
• Neurofibromatosis (von Recklinghausen)
• Tuberous Sclerosis
• Sturge-Weber Sy (Encephalofacial Angiomatosis)
• von Hippel-Lindau Disease
• Neurocutaneous Melanosis

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Neurofibromatosis - Von Recklinghausen

• Dominant inheritance
• Multiple neurofibromas
• Central - CNS
• peripheral nerves
• Increased incidence of
• meningioma
• glioma
• schwannoma - bilateral VIII N.
• Cafe-au-lait (melanosis) in skin
• Elephantiasis increased connective tissue

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Von Recklinghausens Disease
Café-au-lait spots
Multiple neurofibromas
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Von Recklinghausen Disease
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Neurofibromatosis Type II

• Bil Schwannomas
• Meningiomas
• Gliomas
• Pheochromocytomas

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Von Recklinghausen Disease
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Plexiform Neurofibroma
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Café-au-lait spots
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Plexiform Neurofibroma
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Malignant Neurofibroma
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Traumatic Neuroma
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• Schwannoma
• Schwann cells
• Compress the nerve trunk
• Encapsulated
• Easily resectable without nerve damage
• Microscopic
• Antony A and B fibers
• Verocay bodies

• Neurofibroma
• Schwann cells, neurites, fibroblasts
• Fusiform and involves nerve trunk
• Not encapsulated
• Not resectable without sacrificing nerve
• Micro- Intermingled cells with wavy nuclei

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Metastatic tumors

• 25 times more common than primary (breast, lung,
  prostate and kidney tumors, and lymphoma)
• Plain-xray less sensitive.
• Bone scans / MRI sensitive.
• Multiple myeloma common in adults.

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intramedullary glioblastoma.

• MRI is from a 19-year-old man with 4-month
  history of progressive motor loss and inability
  to ambulate.

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intramedullary glioblastoma.

• MRI was produced from a 19-year-old man with
  4-month history of progressive motor loss and
  inability to ambulate.

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Ganglio-glioma

• 30y male,
• 2 year history of numbness left buttock.
  Progressive bladder and bowel dysfunction urinary
  tract infections.
• various sensory abnormalities burning and
  numbness in the perineum and difficulty in
  sensing the need to empty his bowels

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Paraspinal teratoma

• The patient was a previously healthy 20 month old
  boy who presented to the Emergency Room at
  Children's Hospital of Pittsburgh with flaccid
  paralysis of the lower extremities.