Paul D Ackerman1, Ahmad Khaldi, John F Shea. 1. Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL 60153, USA. packerman@lumc.edu
Abstract
BACKGROUND CONTEXT: Hemangiopericytoma (HPC) occurs infrequently in the central nervous system. Spinal involvement is particularly uncommon; and intradural localization is rare. Here, we describe an intradural extramedullary thoracic HPC that went undiagnosed initially on computed tomography scan of the abdomen. PURPOSE: To describe the clinical presentation and operative management of a patient diagnosed with an intradural extramedullary thoracic HPC that was missed on initial workup. We also describe the pathologic features of HPC. STUDY DESIGN: Case report. METHODS: Chart review and literature search. CASE: A 58-year-old man presented with acute weakness of the lower extremities and bladder and bowel incontinence. Magnetic resonance imaging of his spine revealed a T10 intradural extramedullary lesion that displaced the cord to the right. RESULTS: The patient was taken emergently to surgery for T9-T11 laminectomy and en bloc resection of the tumor. The lesion was identified and resected. Histology revealed randomly oriented tumor cells with irregular capillaries consistent with HPC. Postoperatively, the patient had an improved neurological examination, and he continued to do so with intense physical therapy. CONCLUSION: The standard treatment for HPC is surgery when the lesion is resectable. Despite gross total resection, there is still a high risk of recurrence and metastasis; therefore, patients should be followed up closely by their physicians with serial postoperative clinical examinations and radiographic imaging.
BACKGROUND CONTEXT: Hemangiopericytoma (HPC) occurs infrequently in the central nervous system. Spinal involvement is particularly uncommon; and intradural localization is rare. Here, we describe an intradural extramedullary thoracic HPC that went undiagnosed initially on computed tomography scan of the abdomen. PURPOSE: To describe the clinical presentation and operative management of a patient diagnosed with an intradural extramedullary thoracic HPC that was missed on initial workup. We also describe the pathologic features of HPC. STUDY DESIGN: Case report. METHODS: Chart review and literature search. CASE: A 58-year-old man presented with acute weakness of the lower extremities and bladder and bowel incontinence. Magnetic resonance imaging of his spine revealed a T10 intradural extramedullary lesion that displaced the cord to the right. RESULTS: The patient was taken emergently to surgery for T9-T11 laminectomy and en bloc resection of the tumor. The lesion was identified and resected. Histology revealed randomly oriented tumor cells with irregular capillaries consistent with HPC. Postoperatively, the patient had an improved neurological examination, and he continued to do so with intense physical therapy. CONCLUSION: The standard treatment for HPC is surgery when the lesion is resectable. Despite gross total resection, there is still a high risk of recurrence and metastasis; therefore, patients should be followed up closely by their physicians with serial postoperative clinical examinations and radiographic imaging.
Authors: Ali Shirzadi; Doniel Drazin; Marcus Gates; Neda Shirzadi; Serguei Bannykh; Sergei Banykh; Xuemo Fan; Leonel Hunt; Eli M Baron; Wesley A King; Terrence T Kim; J P Johnson; J Patrick Johnson Journal: Eur Spine J Date: 2013-01-05 Impact factor: 3.134