Extradural Dumbbell-Shaped Tuberculoma Masquerading as Nerve Sheath Tumor: Case Report and Review of Literature.
Aged
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Nerve Sheath Neoplasms
/ diagnosis
Peripheral Nervous System Diseases
/ diagnostic imaging
Peripheral Nervous System Neoplasms
/ diagnosis
Spinal Nerve Roots
/ diagnostic imaging
Tomography, X-Ray Computed
Tuberculoma
/ diagnostic imaging
Dumbbell-shaped tumor
Neural-foraminal widening
Spinal tuberculosis
Tuberculoma
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
25
06
2019
revised:
22
07
2019
accepted:
23
07
2019
pubmed:
2
8
2019
medline:
29
1
2020
entrez:
2
8
2019
Statut:
ppublish
Résumé
Spinal tuberculosis has been listed as a rare cause of neuroforaminal widening with only 2 previous reports in the literature. Here, we report the third case of an extradural tuberculoma extending through and expanding the neural foramen closely masquerading as a nerve sheath tumor including, to the best of our knowledge, the first description of magnetic resonance imaging, operative, and histopathology findings. A 65-year-old Nigerian man presented with signs and symptoms of worsening thoracic myeloradiculopathy for the past month. Imaging found an extradural dumbbell-shaped lesion involving the spinal canal, neural foramen, and paraspinal area with a combination of solid and cystic components causing bony remodeling of the pedicle and vertebral body, as well as enlargement of the neural foramen. Surgery was performed to resect the mass, and pathology postoperatively demonstrated caseating granulomas, rare thin elongated organisms on Ziehl-Neelsen staining, and involvement of nerve fascicles. This case illustrates that a tuberculoma can have many of the features of a benign neoplasm, such as encapsulation, appearance of a slow rate of growth, and development of necrosis or even cystic degeneration. With the specific findings of entrapped nerve fascicles, we postulate that the lesion represents a nerve sheath tuberculoma rather than spinal tuberculosis of the pedicle or posterior elements. Furthermore, only a lesion of the nerve sheath would have the characteristic dumbbell appearance as it extends through the foramen.
Sections du résumé
BACKGROUND
BACKGROUND
Spinal tuberculosis has been listed as a rare cause of neuroforaminal widening with only 2 previous reports in the literature. Here, we report the third case of an extradural tuberculoma extending through and expanding the neural foramen closely masquerading as a nerve sheath tumor including, to the best of our knowledge, the first description of magnetic resonance imaging, operative, and histopathology findings.
CASE DESCRIPTION
METHODS
A 65-year-old Nigerian man presented with signs and symptoms of worsening thoracic myeloradiculopathy for the past month. Imaging found an extradural dumbbell-shaped lesion involving the spinal canal, neural foramen, and paraspinal area with a combination of solid and cystic components causing bony remodeling of the pedicle and vertebral body, as well as enlargement of the neural foramen. Surgery was performed to resect the mass, and pathology postoperatively demonstrated caseating granulomas, rare thin elongated organisms on Ziehl-Neelsen staining, and involvement of nerve fascicles.
CONCLUSIONS
CONCLUSIONS
This case illustrates that a tuberculoma can have many of the features of a benign neoplasm, such as encapsulation, appearance of a slow rate of growth, and development of necrosis or even cystic degeneration. With the specific findings of entrapped nerve fascicles, we postulate that the lesion represents a nerve sheath tuberculoma rather than spinal tuberculosis of the pedicle or posterior elements. Furthermore, only a lesion of the nerve sheath would have the characteristic dumbbell appearance as it extends through the foramen.
Identifiants
pubmed: 31369884
pii: S1878-8750(19)32089-3
doi: 10.1016/j.wneu.2019.07.173
pii:
doi:
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
47-51Informations de copyright
Copyright © 2019. Published by Elsevier Inc.