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Case 1148: A Female in Her 6th Decade with Spinal Cord Mass

Authors: Simmi Patel, M.D. and Daniel F. Marker, M.D., PhD

Clinical History

A female in her 6th decade presented to an outside institution 3 years ago with initial symptoms of difficulties walking and paresthesia. MRI showed an intradural extramedullary mass with some contrast enhancement in the thoracic spinal cord. The mass was initially resected, and a diagnosis was issued. The tumor recurred 3 years later and was re-resected.

Figure 1
Figure 1: MRI of the spine showing a partially enhancing intradural, extramedullary mass (highlighted in red).


Microscopic Examination

Initial histologic sections showed a neoplasm composed of atypical pleomorphic cells arranged in a papillary/pseudoangiomatous growth pattern. An extensive immunohistochemical stain panel was conducted seen in table 1. The tumor was mostly positive for EMA (patchy) and vimentin (diffuse). The Ki-67 proliferation index was 20-25%.

Table 1
Table 1: Summary of Ancillary Studies
Figure 2
Figure 2: H&E, 4X magnification
Figure 3
Figure 3: H&E, 10X magnification
Figure 4
Figure 4: H&E, 40x magnification
Figure 5
Figure 5: EMA immunohistochemical stain, 40x magnification

 

Molecular Studies

Table 2
Table 2. Summary of molecular findings


Diagnosis and Discussion