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Intradural spinal granular cell tumor.

Vaghasiya VL, Nasit JG, Parikh PA, Trivedi PP - Asian J Neurosurg (2014)

Bottom Line: Granular cell tumor is a rare, usually benign tumor with classical histomorphology.We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord.Knowledge of which is important as subsequent prognosis differs from other tumor at same location.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.

ABSTRACT
Granular cell tumor is a rare, usually benign tumor with classical histomorphology. Location of tumor varies widely within body, but spine is distinctly a rare location for this tumor. We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord. Knowledge of which is important as subsequent prognosis differs from other tumor at same location.

No MeSH data available.


Related in: MedlinePlus

The neoplastic cells are strongly and diffusely immunoreactive with S-100 protein (nuclear and granular cytoplasmic staining). Cells are negative for EMA (right). Mib-1 is less than 1% (left)
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Figure 3: The neoplastic cells are strongly and diffusely immunoreactive with S-100 protein (nuclear and granular cytoplasmic staining). Cells are negative for EMA (right). Mib-1 is less than 1% (left)

Mentions: A 13-year-old female was operated outside for spinal tumor. As only subtotal excision was possible, patient was referred to our hospital for further management of tumor which was diagnosed, histopathologically, as low grade glioma. Reviewing clinical details, patient had pain in left lower limb since four years, developed difficulty in walking and swelling in lumbar region of back since one year. She had decreased superficial sensations along with paraesthesia in both the lower limbs below first lumbar dermatome and the motor power was reduced and graded as 4/5. Her bowel-bladder functions were unaffected. Her preoperative magnetic resonance imaging (MRI) of the spine showed well-defined intradural extramedullary lobulated lesion measuring 2.5 cm (AP) × 3.2 cm (RL) × 6.6 cm (SI) which was hypointense on T2-weighted images and isointense on T1-weighted images. [Figure 1] Post contrast study showed homogenous enhancement of lesion. Lesion caused widening of spinal canal, scalloping of adjacent vertebral bodies, splaying of posterior laminae, widening of neural foramina and compressing exiting nerve roots and couda equina nerve roots of L1-3. Radiological consideration included nerve sheath tumor or ependymoma. Her postoperative MRI showed a residual heterogeneously enhancing large intraspinal mass measuring 6.5 × 1.7 cm on sagital plane. Her biopsy slides were reviewed at our department which showed sheets and nests of large polyhedral tumor cells. Cells had round-to-oval, hyperchromatic-to-vesicular nuclei with irregular nuclear membrane, mild pleomorphism, but mitoses were lacking. Many nuclei showed intranuclear pseudoinclusions. Cells had abundant eosinophilic, fine-to-coarse granular cytoplasm with indistinct cellular borders giving a syncytial appearance. The islands of tumor were separated by delicate fibrovascular tissue. [Figure 2] The tumor cells were strongly and diffusely immunoreactive with S-100 protein and neuron-specific enolase (NSE). There was no reaction with epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP). Mib-1 index was less than one percent. Overall, these findings were characteristic of a granular cell tumor. [Figure 3] As significant symptomatic/clinical improvement was achieved, patient was managed with regular follow-up only and doing well till date.


Intradural spinal granular cell tumor.

Vaghasiya VL, Nasit JG, Parikh PA, Trivedi PP - Asian J Neurosurg (2014)

The neoplastic cells are strongly and diffusely immunoreactive with S-100 protein (nuclear and granular cytoplasmic staining). Cells are negative for EMA (right). Mib-1 is less than 1% (left)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129585&req=5

Figure 3: The neoplastic cells are strongly and diffusely immunoreactive with S-100 protein (nuclear and granular cytoplasmic staining). Cells are negative for EMA (right). Mib-1 is less than 1% (left)
Mentions: A 13-year-old female was operated outside for spinal tumor. As only subtotal excision was possible, patient was referred to our hospital for further management of tumor which was diagnosed, histopathologically, as low grade glioma. Reviewing clinical details, patient had pain in left lower limb since four years, developed difficulty in walking and swelling in lumbar region of back since one year. She had decreased superficial sensations along with paraesthesia in both the lower limbs below first lumbar dermatome and the motor power was reduced and graded as 4/5. Her bowel-bladder functions were unaffected. Her preoperative magnetic resonance imaging (MRI) of the spine showed well-defined intradural extramedullary lobulated lesion measuring 2.5 cm (AP) × 3.2 cm (RL) × 6.6 cm (SI) which was hypointense on T2-weighted images and isointense on T1-weighted images. [Figure 1] Post contrast study showed homogenous enhancement of lesion. Lesion caused widening of spinal canal, scalloping of adjacent vertebral bodies, splaying of posterior laminae, widening of neural foramina and compressing exiting nerve roots and couda equina nerve roots of L1-3. Radiological consideration included nerve sheath tumor or ependymoma. Her postoperative MRI showed a residual heterogeneously enhancing large intraspinal mass measuring 6.5 × 1.7 cm on sagital plane. Her biopsy slides were reviewed at our department which showed sheets and nests of large polyhedral tumor cells. Cells had round-to-oval, hyperchromatic-to-vesicular nuclei with irregular nuclear membrane, mild pleomorphism, but mitoses were lacking. Many nuclei showed intranuclear pseudoinclusions. Cells had abundant eosinophilic, fine-to-coarse granular cytoplasm with indistinct cellular borders giving a syncytial appearance. The islands of tumor were separated by delicate fibrovascular tissue. [Figure 2] The tumor cells were strongly and diffusely immunoreactive with S-100 protein and neuron-specific enolase (NSE). There was no reaction with epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP). Mib-1 index was less than one percent. Overall, these findings were characteristic of a granular cell tumor. [Figure 3] As significant symptomatic/clinical improvement was achieved, patient was managed with regular follow-up only and doing well till date.

Bottom Line: Granular cell tumor is a rare, usually benign tumor with classical histomorphology.We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord.Knowledge of which is important as subsequent prognosis differs from other tumor at same location.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.

ABSTRACT
Granular cell tumor is a rare, usually benign tumor with classical histomorphology. Location of tumor varies widely within body, but spine is distinctly a rare location for this tumor. We report a rare case of granular cell tumor involving intradural extramedullary portion of lumbar region of spinal cord. Knowledge of which is important as subsequent prognosis differs from other tumor at same location.

No MeSH data available.


Related in: MedlinePlus