primary tumors of the spine (AO) Flashcards
what are the benign tumors of the spine?
- osteoid osteoma
- osteoblastoma
- Giant cell tumors
- aneurysmal bone cyst
- hemangioma
malignant tumors of the spine
- chondrosarcoma
- osteosarcoma
- Ewings sarcoma
- Chordoma
what is the most common primary spine tumor?
vertebral hemangioma
Spinal tumors are referred to by their location in the spine. What are the three location?
- intradural-extramedullary
- intramedullary
- extradural.
How many % of spinal tumors are extradural?
55%
How many % of spinal tumors are intradural-extramedullar?
40%
What is the most common intradural-extramedullary tumor?
- meningiomas
- schwannomas and neurofibromas
- filum terminale ependymomas
how many % of the spinal tumors are intramedullary?
5%
What are the two most common intramedullary tumors of the spinal cord?
- Ependymomas
- Astrocytomas
Where in the spine is Astrocytomas usually found?
- Thoracic
- cervical
Where are ependymomas most often located in the spine according to EANS homepage…..
In the filum.
Which is the most common intramedullary neoplasm in adults?
ependymoma comprising 60% of all glial spinal cord tumors.
Which is the most common intrmedullary spinal neoplasm in pediatrics?
Which is the second most common intramedullary neoplasm in pediatric pop?
Ependymoma
What genetic disease is associated with spinal ependymomas?
NF 2
Which are the most common clinical signs of intramedullary ependymomas?
- pain, * weakness, * sensory changes
Where, inside of the medulla are ependymomas usually located, and therefore explain a frequent presentation symptom?
They are centrally located and proximal to the spinothalamic tract, which explains frequent presentation w sensory symptoms.
What was thought and what is truth about the cell-pathology of ependymomas?
They were thought to arise from ependymal cells lining the central canal.
They ACTUALLY arise from progenitor cells or radial glia-like stem cells.
Which is the classical microscpopic finding of spinal ependymomas?
Perivascular pseudorosettes.
What WHO grade is the usual for spinal ependymoma?
grade 2
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?
They have MYCN-amplification.
Where are the most common sites for spinal ependymomas according to radiopedia?
44% cervical
23% cervical extending to thoracic
26% thoracic.
MRI is the modality of choice to identify ependymoma. What are the general findings to look for?
- 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.
Describe T1, T2 and T2 Gd for ependymomas
T1- isointense to hypointense
T2- hyperintense
-peritumoral edema in 60%
-“cap sign” in 20-33%
T1gd - virtually all enhance strongly, somewhat inhomogenously.
What is a “cap sign”?
its a hypointense hemosiderin rim.
Is a “cap sign” pathognomonic for ependymoma?
No. its suggestive. It may also occur in hemangioblastoma and paraganglioma.
How does ependymomas grow?
They grow slow.
Compress surrounding tissue, dont infiltrate. Almost always leaving a cleavage plane.
If not MYCN amplificated, what is the treatment and prognosis of spinal ependymomas?
Curative excision = 50%
5 y survival then 85%, recurrence rare.
Non-complete resection; survival rate 57%.
Which are the main differential diagnostic options on MRI?
no1= spinal astrocytoma.
(*spinal cavernous malformation *diffuse midline glioma H3 K27 altered)
How to differentiate spinal astrocytoma and spinal ependymoma on MRI?
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.
How is spinal cavernous malformations seen on MRI in the spine?
- No enhancement
- complete hemosiderin ring.
What is the second mot common spinal cord tumor in adulats and first in pediatric pop?
Spinal astrocytoma.
40% of intramedullary tumors in adults.
60% of intramedullary tumors in children.
Spinal astrocytoma is associated to a genetic syndrome. What?
NF 1
What specific type of spinal astrocytoma is more often associated to NF1?
high-grade astrocytoma with piloid features.
Common presentation signs clinically for spinal astrocytomas?
Pain, sensory (53%), weakness (41%)
What type of cells does both intracranial and spinal astrocytomas arise from?
Astrocytic glial cells
Histologic grade of spinal astrocytoma differ from the brain. how?
Its usually lower grade. both for children and adults.
How many % are low grade of astrocytomas in the spine in adults and peds?
75% adults 80% peds.
How are spinal astrocytomas growing?
They are hypercellular and do not have a capsule nor a cleavage plane. Overall 60% (mostly high grade) spread leptomeningealy.
What is the average length of an spinal astrocytoma?
4-7 vertebral body segments.
Where in the spine are astrocytoma located?
67% thoracic
49% cervical and many both.
It is more common that the entore cord is involved in children than in adults. What is that called?
Holocord presentation
Location that is rare in astrocytoma and somewhat more common in especially myxopapillary ependymomas
conus medullaris 3%
filum terminale -almost enevr
What is the treatment of astrocytomas?
Surgical excision is usually the treatment of choice. However almost always histologically incomplete.
Spinal cord astrocytomas differ a lot in prognosis between adults and children. How and why?
Children tend to be associated w good prognosis. behave like grade I cerebellar pilocytic astrocyomas and displace neural tissue rather than infiltrating it.
1st differential diagnosis to AStrocytoma and what might help differentiating?
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)
