Download MRI Lumbar Spine Extradural Meningeal Tumor with

MRI Lumbar Spine
Extradural Meningeal Tumor with Leptomeningeal involvement in the Conus Medullaris
L: The cancer is located in the spinal cord as you can see from this sagittal MRI image. The area
of interest is located at the level of the five lumbar vertebrae and the sacrum on this image. The
area of the spinal cord treated is actually from the xiphoid to the pubic symphysis. At the level of
L1-2, the spinal cord terminates into the conus medullaris, and the cauda equina begins. The
radiology report stated that this is an extradural meningeal tumor, and there is leptomeningeal
involvement in the conus medullaris area. The leptomeninges consist of the arachnoid and the
pia mater; the space between the two contains the CSF. When tumor cells enter the CSF, they are
transported throughout the nervous system by CSF flow, causing either multifocal or diffuse
infiltration of the leptomeninges. This tumor is the result of metastatic spread from the brain.
CAT: The adjacent tissues are not necessarily affected. There is no compression of the cord by
bony metastasis like there would be for typical radiation treatment of the spinal cord. There are
some bone metastases obviously seen in the twelfth thoracic and second and fourth lumbar
vertebrae and S1, but they are not compressing the cord. The areas of high density along the cord
are probably areas of fat that show up better with the gadolinium-enhanced scan.
CSB: The tumor appears in the spinal cord with a mottled appearance. The cord appears streaky.
There is no definite border to the tumor. It appears to be a heterogeneous tumor and comparable
in density to the intervertebral disks.
DC: The cauda equina is the collection of lumbar and sacral spinal nerve roots that go in a
caudal direction to emerge from their respective foramina. Tumors of the cauda equina and the
conus medullaris manifest with progressive symptoms, including pain, motor weakness, sensory
deficit, and bowel and bladder symptoms. This tumor is a meningeal metastatic tumor of the
cauda equina. Extradural tumors arise outside the cord and the meninges in the vertebral bodies
and the epidural tissue. Intradural-extramedullary tumors arise inside the dural sac, from the
leptomeninges or the nerve root, but outside the substance of the cord. Intramedullary tumors
arise within the substance of the spinal cord. Tumors of the spinal cord comprise approximately
15% of all central nervous system tumors. They are rare tumors, with an estimated incidence of
0.5–2.5 cases per 100,000 of the population. Extradural spinal cord tumors comprise 55% of all
tumors and include metastatic tumors. Radiation therapy is the primary treatment for malignant
tumors of the spinal cord. Intrathecal chemotherapy is also a standard treatment for
leptomeningeal metastases from solid tumors. Radiotherapy of 24 Gy in eight treatments over
10–14 days is typical.
C: This patient had a history of cigarette smoking for almost 50 years and social drinking. Also,
this patient had prostate cancer approximately 2 years ago and had radiation treatment. His father
died at age 73 of prostate cancer showing a possible hereditary relationship. The patient was
being treated for small-cell lung cancer in 2002. The patient then had metastatic spread to his
liver and brain due to the lung cancer diagnosis. He complained of leg weakness and lost control
of autonomic functions of his bladder and rectum, indicating a problem with his spinal cord.