Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
Ciara D. Harraher, Hannes Vogel, Gary K. Steinberg
ObjectiveAstrocytomas are the most common intramedullary spinal cord tumor (IMSCT) in pediatric and adolescent patients and the incidence decreases with age. There are very few cases of spinal pilocytic astrocytomas (WHO grade 1) reported after the fourth decade. We report the oldest known case of a pathologically confirmed spinal pilocytic astrocytoma.MethodsA 78-year-old female presented with 12 months of bilateral lower extremity numbness. Magnetic resonance imaging (MRI) revealed cord edema extending from C6 to T4. There was a 12mm enhancing intramedullary lesion at the C7-T1 level with an associated cyst. Several years prior, she had seen a neurologist for lower extremity numbness and was diagnosed with peripheral neuropathy.ResultsShe underwent C7-T1 laminectomy with partial resection of the spinal cord tumor and drainage of the cyst. Pathological examination demonstrated a mildly cellular proliferation of astrocytes set in an eosiniphilic fibrillar background. There were numerous Rosenthal fibers and prominent vasculature. There were no malignant features. The pathological diagnosis was consistent with pilocytic astrocytoma, WHO grade 1. The patient returned to her baseline function after several weeks and the imaging remained stable at four months follow-up.ConclusionSpinal pilocytic astrocytomas constitute 90% of IMSCT in patients younger than 10 years and 60% of those in adolescent patients. There are very few reported cases in patients older than fifty. Our patient had an indolent course, cervical-thoracic location, imaging characteristics and pathology that all support pilocytic astrocytoma. This case highlights that low-grade lesions can occur in elderly patients and an aggressive approach may not be indicated.
No comments:
Post a Comment