Weekly Case

Title : Case 670

Age / Sex : 40 / F


Chief complaint : Both arm and leg weakness


Past history : s/p total thyroidectomy due to papillary thyoroid cancer, 3 years ago





What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 이인숙, In Sook Lee/ 부산대학교병원 Pusan National University Hospital


Diagnosis:

Epidural meningioma



Discussion



  • Spinal meningioma


Usually present in the intradural-extramedullary space of the thoracic region (2nd most common intradural spinal tumor)


Occurs most frequently in fifth and sixth decades women


purely extradural spinal meningiomas are rare :  account for only 2.5% to 3.5% of all spinal meningioma 


Gritty foci of calcification are frequently found in spinal meningiomas due to psammoma bodies



  •  MR images


Epidural meningiomas may be en plaque, dumbbell-shaped, or fusiform/ovoid

 en plaque meningiomas, thickened dorsal and ventral dura encircled the spinal cord, forming a C-shape or half ring on the axial MR images

 Epidural meningioma may extend through the intervertebral foramen to the outer part of the spinal canal

 Another characteristic of epidural meningiomas is calcification, which is uncommon in spinal intradural meningiomas

 Epidural spinal meningiomas show more aggressive behavior than intradural meningiomas

 Postoperative recurrence of epidural meningioma is not rare

 En plaque epidural meningioma shows the same growth pattern and signal as a lymphoma

   -- lymphomas are mostly observed on the ventral side of the dura and are characterized by formation of a paravertebral soft-tissue mass

      and infiltration of adjacent bone



 Reference



  • L.H. Zhang and H.S. Yuan. Imaging appearancew and pathologic characteristics of spinal epidural meningioma, AJNR 

  • Yamada S, Kawai S, Yonezawa T, Masui K, Nishi N, Fujiwara K. Cervical extradural en-plaque meningioma Neurologia medico-chirurgica 2007;47:36-39

  • Spinal Extradural Meningioma: A Case Report and Review of the Literature. J Korean Soc Radiol. 2018 Jul;79(1):11-17. English.



Correct Answer
Total applicants 30 Correct answers 6
Name Institution
김기욱 국군수도병원, 전문의
변성환 전공의
윤유성 순천향대 부천병원, 전문의
김현진 서울성모병원, 전공의
정치형 단국대학교병원, 전공의
안태란 길병원, 전문의
Semi-Correct Answer
Total applicants 30 Semi-Correct answers 18
여현정 전문의
김형민 연세의대 강남세브란스병원, 전문의
이현규 전문의
윤선근 전공의
강지희 전문의
이규정 고대안암병원, 전문의
조영민 전문의
장민영 국민건강보험공단 일산병원, 전문의
이동규 경인지방병무청, 전문의
김동언 국군양주병원, 전문의
권기언 서울아산병원, 전문의
이승보 서울아산병원, 전문의
박진희 서울아산병원, 전문의
임윤진 전공의
송윤아 전문의
노지훈 중앙보훈병원, 전공의
한유비 전문의
김성진 365병원, 전문의


Comment