Neoplasms of the Spine

Question 1

What are clinical manifestations of spinal tumors?

Answer 1

Tend to be slowly growing masses that have subtle clinical manifestations - slowly progressive

Question 2

In general, in terms of spinal tumors, it is important to classify them as either:

Answer 2

Intramedullary/extramedullary (intra/extradural)

Question 3

What is a potential pitfall in diagnosis of intramedullary tumor?

Answer 3

Tumor vs. demyelinating plaque (both increased T2 signal).

Question 4

What are some ways of differentiating intramedullary demyelinating plaque from tumor?

Answer 4

Demyelinating plaque:

• Flame-shaped
• Rarely cause enlargement of the cord
• Cysts almost never present
• Looking at Brain can help diagnosis
• If uncertainty persists - can f/u in 4-6 weeks - should be smaller with different enhancement characteristics
• Tumor:
  
  • Round/Ovoid in shape
  • Do cause enlargement of cord diameter at time of presentation because they rarely cause symptoms when less than 2 cm in diameter.

If uncertain - can f/u 4-6 weeks - this delay should not impact outcome, even if tumor. But, a biopsy of acute demyelinating plaque can leave a patient with worse neurological deficit.

Question 5

What is this?

Answer 5

Astrocytoma (enlarges cord, >2cm) mass effect

Question 6

What is this?

Answer 6

Demyelinating plaque (small, less than 2 cm)

• If question - can f/u in 6 weeks (shouldn’t impact tumor treatment)
• Tumor should grow and have similar enhancement
• plaque should be smaller, different enhancement pattern.