Abstract
Introduction: The diversity of anatomic structures in the spinal region challenges both the clinician and a pathologist with distinct and interesting group of spinal lesions having wide spectrum of clinical and histological presentations. The first step of the diagnostic alogorithm includes the analysis of clinical and radiological features because it narrows down the differential diagnosis to a significant extent. The next step includes the histopathology.
Aim: To analyse the histopathological morphology of spinal cord lesions with clinical and radiological features.
Materials and Methods: The study was carried out in Department of Pathology, S.M.S. Medical College, Jaipur (Rajasthan) from June 2018 to November 2019. Our study comprised of a total 85 surgical resection specimens of lesions of spinal cord and its coverings. All cases were analyzed by examining hematoxylin and eosin stained slides with use of special stains and immunohistochemistry, as needed.
Results: Most of the cases were in the age group 31 – 40 years. The female to male ratio 1.12:1. Backache was the most frequent symptom followed by weakness of lower limbs. Thoracic segment was most commonly involved, followed by lumbar and cervical. Most common site was intradural extramedullary followed by extradural and intradural intramedullary. 60% neoplastic, 21.18% inflammatory and 18.83% non-neoplastic lesions. Commonest was Nerve sheath tumours (24.70%) followed by meningioma (12.94%),ependymoma (9.41%), astrocytoma (5.88%).16.47% of tuberculosis. 2 cases each of hemangioblastoma, lymphoma, and metastatic carcinoma respectively.
Conclusion: The combination of clinical, radiological and histopathological features forms the basis of the multi-disciplinary diagnostic approach towards the spinal cord and its covering lesions.
Keywords: Spinal cord lesions, Extradural, Intradural, Intramedullary, Histopathology.
References
- Lannering B, Sandstrom PE, Holm S, Lundgren J, Pfeifer S, Samuelsson U et al. Classification, incidence and survival analysis of children with CNS tumors diagnosed in Sweden 1984- 2005 . Acta Paediatr. 2009;98(10):1620-7.
- Parsa AT, Chi JH, Acosta FL Jr, Ames CP, McCormick PC. Intramedullary spinal cord tumors: molecular insights and surgical innovation. Clin Neurosurg. 2005;52:76–84.
- Yen HL, Lee RJ, Lin JW, Chen HJ. Multiple tuberculomas in the brain and spinal cord: a case report. J Neurosurg Spine. 2003;28:499–502.
- Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG et al. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equine. J Neurosurg Spine. 2010;13:67–77.
- Moein P, Behnamfar O, Farajzadegan Z. A 12-year old study on primary spinal cord tumors in Isfahan, Iran. J Res Med Sci. 2013 Jan;18(1):17-21.
- Dikondwar AR, Dani AA. Spinal space occupying lesions – pathologic spectrum. J Med Sci Health. 2016;2(1):24-9.
- Gadgil NM, Chaudhari CS, Margam SR, Umar Khan M, Kumavat PV, Kshirsagar GR. A clinicopathological study of lesions of spinal cord and its coverings: a tertiary care hospital experience. Ann Pathol Lab Med. 2016;3:148-56.
- Binayke RS, Sisodia SM, Joshi TC. Clinico pathological study of parenchymal lesions of spinal cord. Ann Pathol Lab Med. 2018;5(12):967-72.
- Patil MB, Karandikar MN. “Retrospective analysis of intracranial and intraspinal space occupying lesions at a tertiary care center- a five year study.” Int J Res – Granthaalayah. 2018;6(10):100-9.
- Tathe SP, Parate SN, Meshram SA, Randale AA, Bhatkule MA. Histopathological spectrum of spinal space occupying lesions. J Med Sci Clin Res. 2019;07 (01):1140-45 .
- Schellinger KA, Propp JM, Villano JL, McCarthy BJ. Descriptive epidemiology of primary spinal cord tumors. J Neurooncol. 2008;87:173–79.
- Kaye AH, Giles GG, Gonzales M. Primary central nervous system tumors in Australia: a profile of clinical practice from the Australian brain tumor register. Aust N Z J Surg. 1993;63:33–8.
- Abbasi SS, Senoglu M, Theodore N, Workman RK, Gharabaghi A, Feizerfan I et al. Microsurgical management of spinal schwannomas: evaluation of 128 cases. J Neurosurg Spine. 2008;9(1):40-47.
- Adam Y, Benezech J, Blanquet A, Fuentes JM, Bousigue JY, Debono B et al. Intramedullary tumors: results of a national investigation in private neurosurgery. Neurochirurgie. 2010;56(4): 344-9.
- Samartzis D, Gills CC, Shih P, O’Toole JE, Fessler RG. Intramedullary spinal cord tumors: part 1epidemiology, pathophysiology and diagnosis. Global Spine J. 2015;5:425-35.
- Gebauer GP, Farjoodi P, Sciubba D, Gokaslan ZL, Riley LH, Bruce WA et al. Magnetic resonance imaging of spine tumors: classification, differential diagnosis and spectrum of disease. J Bone Joint Surg Am. 2008;90:146-62.
- Jain AK, Singh S, Sinha S, Dhamni IK, Kumar S. Intraspinal tubercular granulomaan analysis of 17 cases. Indian J Orthop. 2003;37(3):1-4.
- Hirano K, Imagama S, Sato K, Kato F, Yukawa Y, Yoshihara H, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J. 2012;21(10):2019-26.
- Craciunas SC, Gorgan MR, Cirstea CM, Aschie M. Intramedullary tumors - clinical, radiological and histological correlations. Roman Neurosurg. 2011;18 (2):1-16.
- Odebode TO, Udoffa U, Nzeh D. Cervical myelomeningocele and hydrocephalus without neurological deficit: a case report. Am-Euras J Sc Res. 2007;2(1): 60-62.
Corresponding Author
Gandhi Sapna
Associate Professor, Department of Pathology, SMS Medical, College, Jaipur, Rajasthan
DOI: https://dx.doi.org/10.18535/jmscr/v8i6.12
