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Age / Sex : 67 / F
Chief complaint: complaint of two months of lower back pain with a tingling sensation
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 박희진(Hee Jin Park), 성균관대강북삼성병원(Kangbuk Samsung Hospital)
Diagnosis: Xanthogranuloma
Discussion
Findings:
: 1.7 x 0.9 cm oval-shaped
well-defined IDEM lesion at the L1 level
: mixed signal intensity on the T1-weighted image and high
signal intensity on T2-WI
: Central homogenous enhancement after contrast
administration
Differential Diagnosis: The differential diagnosis contains
some IDEM tumors, including spinal ependymoma, astrocytoma, and schwannoma.
Spinal ependymoma and astrocytoma can be considered in the location of the
lesion. Spinal ependymomas are generally hyper-intense on T2-WI and
hypo-intense on T1-WI that is often heterogeneous. Ependymomas nearly always
show contrast enhancement, though are not always homogenous. Astrocytomas, in
contrast, are iso- to slightly hypo-intense on T1WI, hyper-intense on T2WI, and
commonly have associated cysts. They enhance less intensely and are more
eccentric than ependymomas. Schwannomas can be considered in the shape of the
lesion. Schwannomas also are generally hypo or iso-intense on T1WI and
hyper-intense on T2WI that is often heterogeneous, and are frequently
associated with hemorrhage, intrinsic vascular changes, cyst formation, and
fatty degeneration.
Diagnosis: Xanthogranuloma
References:
1. Dehner LP. Juvenile
xanthogranulomas in the first two decades of life : a clinicopathologic study
of 174 cases with cutaneous and extracutaneous manifestations. Am J Surg Pathol
2003:27: 579-593
2. Inoue H, Seichi A,
Yamamuro K, Kojima M, Kimura A, Hoshino Y : Dumbbell-type juvenile
xanthogranuloma in the cervical spine of an adult. Eur Spine J 2011:2:343-347
3. Iwasaki Y, Hida K,
Nagashima K. Cauda equina xanthogranulomatosis. Br J Neurosurg 2001:15:72-73
4. Lee SJ, Jo DJ, Lee SH,
Kim SM. Solitary Xanthogranuloma of the Upper Cervical Spine in a Male Adult. J
Korean Neurosurg Soc. 2012:51(1) :54–58
Ayres
WW, Haymaker W. Xanthoma and cholesterol granuloma of the choroid plexus:
Report of the pathological aspects in 29 cases. J Neuropathol Exp Neurol 1960:19:280-295
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