Tumors of the Spine and Spinal Cord Flashcards
About 15% of primary CNS tumors are intraspinal and most spinal tumors are benign presenting with compression rather than invasion. Which of the following statements regarding these tumors is not true?
● A. Metastasis is only found in the extradural compartment
● B. 55% are extradural tumors
● C. 40% are intradural extramedullary tumors and arise mostly from leptomeninges or roots
● D. Only 5% are intramedullary spinal cord tumors
● E. Lymphoma may occur in all three compartments and are divided into primary or secondary (metastasis)
A. Metastasis is only found in the extradural compartment
Most of the extradural tumors are metastasis which can be osteolytic like lymphoma, lung, breast, or prostate or these can be osteoblastic like prostate carcinoma (CA) which is most common in men while in females breast CA is most common. Other extradural tumors include the following except?
● A. Chordomas and osteoid osteoma
● B. Osteoblastoma and aneurysmal bone cyst
● C. Chondrosarcoma and osteochondroma
● D. Vertebral hemangioma and giant cell tumors
● E. Meningioma and neurofibromas
E. Meningioma and neurofibromas
Intradural extramedullary tumors include meningiomas, neurofibromas, lipomas, or rarely metastasis. Which of the following are the most common intramedullary spinal cord tumors?
● A. Astrocytoma and ependymoma including myxopapillary ependymoma
● B. Malignant glioblastoma and dermoid
● C. Epidermoid and teratoma
● D. Lipoma and hemangioblastoma
● E. Neuroma and syringomyelia
A. Astrocytoma and ependymoma including myxopapillary ependymoma
A patient presents with an intradural extramedullary spinal cord tumor, which occurs mostly in 40 to 70 years of age and affects females 4 times more than males. These are mostly found in the thoracic region and in 68% of cases, these tumors are lateral to the spinal cord, in 15% they are anterior, while in 18% they are posterior. Which tumor fulfills all these characteristics?
● A. Neurofibroma
● B. Schwannoma
● C. Meningioma
● D. Lipoma
● E. Lymphoma
C. Meningioma
Spinal schwannomas are intradural extramedullary spinal tumors that are mostly slow growing benign tumors and arise mostly (75%) from dorsal (sensory) rootlets with early symptoms of radicular pain. All of the following statements regarding Asazuma et al classification of dumbbell spinal schwannomas are correct except?
● A. Type 1 tumors are intradural and extradural tumors and are restricted to the spinal canal. These can be operated through posterior approach
● B. Type 2 tumors are all extradural and are subclassified as 2a (do not extend beyond the neural foramina), 2b (inside the spinal canal and paravertebral), and 2c (foraminal and paravertebral). Tumors 2a and 2b can be operated posteriorly
● C. Type 3a tumors are intradural and extradural foraminal, and 3b tumors are intradural and extradural paravertebral, with only 3a and some upper cervical 3b operable posteriorly
● D. Type 4 tumors are extradural intravertebral tumors and can be operated posteriorly
● E. Type 5 tumors are extradural, extralaminar with laminar invasion while type 6 tumors are multidirectional with bone erosion
D. Type 4 tumors are extradural intravertebral tumors and can be operated posteriorly
Ependymomas are the intradural spinal cord tumors that require MRI of the entire neuraxis because of potential for seeding. These are slow-growing benign tumors with male predominance and mostly occur in the 3rd to 6th decades of life. These
are mostly found in conus medullaris, filum terminale, or cauda equina where these are called as what?
● A. Papillary tumors
● B. Myxopapillary ependymomas
● C. End spinal cord tumors
● D. Ependymomas at conus
● E. None of the above
B. Myxopapillary ependymomas
What is the most common presentation of an intramedullary spinal cord tumor?
● A. Pain which can be radicular (increases with Valsalva maneuver and spine movements, especially consider SCT if dermatome is unusual for disk herniation), local (pain during recumbency or nocturnal pain is classic for spinal cord tumors),
or medullary (dysesthetic, nonradicular, and often bilateral)
● B. Motor disturbances
● C. Nonpainful sensory disturbances
● D. Sphincters disturbances
● E. Scoliosis or torticollis
A. Pain which can be radicular (increases with Valsalva maneuver and spine movements, especially consider SCT if dermatome is unusual for disk herniation), local (pain during recumbency or nocturnal pain is classic for spinal cord tumors),
or medullary (dysesthetic, nonradicular, and often bilateral)
It is usually difficult to distinguish intramedullary spinal cord tumors from intradural extramedullary or extradural tumors on clinical grounds. How schwannomas can be distinguished from intramedullary tumors on clinical grounds?
● A. Schwannomas often start with radicular pain that later progress to cord involvement
● B. Most intramedullary spinal cord tumors are located posteriorly in the cord which may cause sensory findings to predominate
● C. Intramedullary spinal cord tumors cause dissociative type of sensory loss with decreased pain and temperature and preserved light touch as in Brown-Sequard syndrome
● D. Urogenital symptoms like difficulty evacuating, retention, and incontinence are early signs in conus or cauda equina lesions
● E. All of the above
E. All of the above
Mainstay of diagnosis for intramedullary tumors is MRI in which ependymoma enhance intensely, often associated with hemorrhage and cysts. While plain radiographs show vertebral body destruction, there is enlarged intervertebral foramina or increased interpedicular distance with fusiform cord widening
on myelography. What is the technical consideration while doing surgery on these tumors?
● A. These tumors should be debulked internally using ultrasonic aspirator and laser
● B. An attempt should be made to make a plane between the tumor and the cord
● C. Total excision is must in all these tumors
● D. No radiotherapy is needed for residual tumors
● E. If cystic component is evident, an attempt should be made to aspirate the whole cyst at the start of surgery
A. These tumors should be debulked internally using ultrasonic aspirator and laser
A patient presents with pain localized to one point on back. MRI shows vertebral body lesion, which is focal, round, hyperintense on T1 and T2 with enhancement on contrast. CT of spine shows multiple, high-density dots on axial images (polka
dot sign), while plain radiograph shows vertically oriented striations (corduroy pattern) or honeycomb appearance. What are the management options for these tumors?
● A. Radiotherapy
● B. Embolization
● C. Vertebroplasty
● D. Surgery (which can be through posterior approach if only posterior elements are involved or if there is VB involvement with no expansion, and anterior corpectomy with strut graft if VB is involved with anterior canal compression or extensive anterior and posterior elements and soft tissue involvement)
● E. All of the above
E. All of the above
Which of the following is the most common extradural tumor of spine?
● A. Neurofibroma
● B. Ependymoma
● C. Aneurysmal bone cyst
● D. Chordoma
● E. Metastases
E. Metastases
Which of the following is the most common intradural extramedullary tumor of spine?
● A. Neurofibroma
● B. Ependymoma
● C. Aneurysmal bone cyst
● D. Chordoma
● E. Metastases
A. Neurofibroma
Which of the following is the most common intradural intramedullary tumor of spine?
● A. Neurofibroma
● B. Ependymoma
● C. Aneurysmal bone cyst
● D. Chordoma
● E. Metastases
B. Ependymoma
Which of the following is the most common location of spinal meningioma?
● A. Upper cervical
● B. Subaxial cervical
● C. Thoracic
● D. Lumbar
● E. Sacral
C. Thoracic
According to Asazuma classification system for dumbbell spinal schwannomas, what is the type of a tumor that is totally
extradural?
● A. 1
● B. 2
● C. 3
● D. 4
B. 2
