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Spine > primary tumors of the spine (AO) > Flashcards

primary tumors of the spine (AO) Flashcards

1
Q

what are the benign tumors of the spine?

A
  • osteoid osteoma
  • osteoblastoma
  • Giant cell tumors
  • aneurysmal bone cyst
  • hemangioma
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2
Q

malignant tumors of the spine

A
  • chondrosarcoma
  • osteosarcoma
  • Ewings sarcoma
  • Chordoma
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3
Q

what is the most common primary spine tumor?

A

vertebral hemangioma

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4
Q

Spinal tumors are referred to by their location in the spine. What are the three location?

A
  • intradural-extramedullary
  • intramedullary
  • extradural.
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5
Q

How many % of spinal tumors are extradural?

A

55%

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6
Q

How many % of spinal tumors are intradural-extramedullar?

A

40%

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7
Q

What is the most common intradural-extramedullary tumor?

A
  • meningiomas
  • schwannomas and neurofibromas
  • filum terminale ependymomas
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8
Q

how many % of the spinal tumors are intramedullary?

A

5%

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9
Q

What are the two most common intramedullary tumors of the spinal cord?

A
  • Ependymomas
  • Astrocytomas
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10
Q

Where in the spine is Astrocytomas usually found?

A
  1. Thoracic
  2. cervical
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11
Q

Where are ependymomas most often located in the spine according to EANS homepage…..

A

In the filum.

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12
Q

Which is the most common intramedullary neoplasm in adults?

A

ependymoma comprising 60% of all glial spinal cord tumors.

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13
Q

Which is the most common intrmedullary spinal neoplasm in pediatrics?

A
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14
Q

Which is the second most common intramedullary neoplasm in pediatric pop?

A

Ependymoma

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15
Q

What genetic disease is associated with spinal ependymomas?

A

NF 2

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16
Q

Which are the most common clinical signs of intramedullary ependymomas?

A
  • pain, * weakness, * sensory changes
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17
Q

Where, inside of the medulla are ependymomas usually located, and therefore explain a frequent presentation symptom?

A

They are centrally located and proximal to the spinothalamic tract, which explains frequent presentation w sensory symptoms.

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18
Q

What was thought and what is truth about the cell-pathology of ependymomas?

A

They were thought to arise from ependymal cells lining the central canal.
They ACTUALLY arise from progenitor cells or radial glia-like stem cells.

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19
Q

Which is the classical microscpopic finding of spinal ependymomas?

A

Perivascular pseudorosettes.

20
Q

What WHO grade is the usual for spinal ependymoma?

A

grade 2

21
Q

In the 5th WHO classification a new group of previous ependymomas that are grade 5, very aggressive, is found. What is special w this group?

A

They have MYCN-amplification.

22
Q

Where are the most common sites for spinal ependymomas according to radiopedia?

A

44% cervical
23% cervical extending to thoracic
26% thoracic.

23
Q

MRI is the modality of choice to identify ependymoma. What are the general findings to look for?

A
  • widened spinal cord
  • well circumscribed
  • tumoral cysts in 22%, non-tumoral cysts in 62%
  • syringohydromyelia in 9-50%
  • in contrast to intracranial ependymomas, calcification is UNcommon.
  • Average length of 4 vertebral body segments.
24
Q

Describe T1, T2 and T2 Gd for ependymomas

A

T1- isointense to hypointense
T2- hyperintense
-peritumoral edema in 60%
-“cap sign” in 20-33%
T1gd - virtually all enhance strongly, somewhat inhomogenously.

25
Q

What is a “cap sign”?

A

its a hypointense hemosiderin rim.

26
Q

Is a “cap sign” pathognomonic for ependymoma?

A

No. its suggestive. It may also occur in hemangioblastoma and paraganglioma.

27
Q

How does ependymomas grow?

A

They grow slow.
Compress surrounding tissue, dont infiltrate. Almost always leaving a cleavage plane.

28
Q

If not MYCN amplificated, what is the treatment and prognosis of spinal ependymomas?

A

Curative excision = 50%
5 y survival then 85%, recurrence rare.
Non-complete resection; survival rate 57%.

29
Q

Which are the main differential diagnostic options on MRI?

A

no1= spinal astrocytoma.
(*spinal cavernous malformation *diffuse midline glioma H3 K27 altered)

30
Q

How to differentiate spinal astrocytoma and spinal ependymoma on MRI?

A

astrocytoma - *eccentric location in the spinal canal.
* ill defined
* hemorrhage uncommon
* involvement of the entire cod diameter and longer cord segements favours astrocytoma.
* patchy irregular contrast enhancement
* bone changes are infrequent.

31
Q

How is spinal cavernous malformations seen on MRI in the spine?

A
  • No enhancement
  • complete hemosiderin ring.
32
Q

What is the second mot common spinal cord tumor in adulats and first in pediatric pop?

A

Spinal astrocytoma.
40% of intramedullary tumors in adults.
60% of intramedullary tumors in children.

33
Q

Spinal astrocytoma is associated to a genetic syndrome. What?

A

NF 1

34
Q

What specific type of spinal astrocytoma is more often associated to NF1?

A

high-grade astrocytoma with piloid features.

35
Q

Common presentation signs clinically for spinal astrocytomas?

A

Pain, sensory (53%), weakness (41%)

36
Q

What type of cells does both intracranial and spinal astrocytomas arise from?

A

Astrocytic glial cells

37
Q

Histologic grade of spinal astrocytoma differ from the brain. how?

A

Its usually lower grade. both for children and adults.

38
Q

How many % are low grade of astrocytomas in the spine in adults and peds?

A

75% adults 80% peds.

39
Q

How are spinal astrocytomas growing?

A

They are hypercellular and do not have a capsule nor a cleavage plane. Overall 60% (mostly high grade) spread leptomeningealy.

40
Q

What is the average length of an spinal astrocytoma?

A

4-7 vertebral body segments.

41
Q

Where in the spine are astrocytoma located?

A

67% thoracic
49% cervical and many both.

42
Q

It is more common that the entore cord is involved in children than in adults. What is that called?

A

Holocord presentation

43
Q

Location that is rare in astrocytoma and somewhat more common in especially myxopapillary ependymomas

A

conus medullaris 3%
filum terminale -almost enevr

44
Q

What is the treatment of astrocytomas?

A

Surgical excision is usually the treatment of choice. However almost always histologically incomplete.

45
Q

Spinal cord astrocytomas differ a lot in prognosis between adults and children. How and why?

A

Children tend to be associated w good prognosis. behave like grade I cerebellar pilocytic astrocyomas and displace neural tissue rather than infiltrating it.

46
Q

1st differential diagnosis to AStrocytoma and what might help differentiating?

A

spinal EPENDYMOMA.
that is
* more common in adults
* scoliosis and bony remodelling is more common in ependymoma
* central location in the spinal canal
* well circumscribed
* 20% hemosiderin capping
* more homogenous contrast enhancement
More frequent and more prominent cysts (intratumoral and polar)

Spine (17 decks)

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