69‐year‐old male with an intradural, extramedullary mass at T12‐L1

Abstract

In 2002, a 55-year-old male patient was referred for neurosurgical consultation after two episodes of speech arrest and a newly diagnosed mass lesion in the superior left temporal gyrus extending to the insula. The patient underwent a pterional craniotomy with partial resection of the tumor. The histopathological examination revealed an oligodendroglioma (WHO II). A follow-up MRI in 2007 demonstrated significant growth of the residual tumor mass (Figure 1A–D). Accordingly, the patient was started on standard therapy with temozolomide. In 2011, MRI showed tumor progression, which prompted additional tumor resection. The histological examination revealed features of anaplastic oligodendroglioma with codeletion of 1p/19q. Postoperative treatment included adjuvant radiotherapy (32 × 1.8 Gy = 57.6 Gy). In June 2015, follow-up MRI revealed a local recurrence consistent with tumor progression. Meanwhile, the patient had undergone surgical resection of adenocarcinoma of the colon, diagnosed in 2015, and treated with adjuvant chemotherapy (FOLFOX4). The decision was made to suspend further treatment and to follow the patient with MRI. Of note, the regression of the tumor mass was observed in the parahippocampal gyrus. In September 2016, 14 years after the initial diagnosis of oligodendroglioma, follow-up MRI of the liver was performed according to the staging protocol for metastatic adenocarcinoma. MRI of the abdomen revealed the incidental finding of an intradural tumor attached to the conus medullaris. MRI of the lumbar spine showed a circumscribed, intradural and extramedullary tumor (11 × 13 × 24 mm). The tumor occupied the spinal canal between Th12-L1, shifting the conus to the left, as well as infiltrating the fibers of the cauda equina (Figure 1E–H). The clinical examination revealed mild paresis of the right leg, in particular, the right hip and foot flexors (M4/5). Laminoplasty was performed at Th12-L1 and the intradural and intramedullary lesion were resected. The postoperative course was uneventful and the patient did not show any new deficits after surgery (Figure 1I–L, postoperative MRI). The histological diagnosis is discussed below in detail.