Spinal Space Occupying Lesions: A Comprehensive Study of Clinico-pathological Spectrum and Measure of Degree of Agreement Between the Diagnostic Modalities

Clinico-pathological spectrum of Spinal Space Occupying Lesions (SOLs)

  • Srinivas DD Gubbala Department of Pathology, Kamineni Institute of Medical Sciences (KIMS), Narketpally, India
  • Sridevi Mattaparti Department of Pathology, Kamineni Institute of Medical Sciences (KIMS), Narketpally, India.
  • Bhavani . Department of Pathology, Kamineni Institute of Medical Sciences (KIMS), Narketpally, India
Keywords: Spinal Space occupying lesions, Nerve sheath tumors, meningioma, Intradural, Extradural

Abstract

Back ground: Spinal SOLs are quite fascinating group of lesions, comprising a minority of central nervous system lesions often resulting in significant morbidity. There is paucity of comprehensive population-based data of these SOLs in Indian subcontinent.    Material and methods: The present study was a retrospective descriptive study conducted at the department of pathology, Kamineni Institute of Medical Sciences for 3 years starting from January 2017 to December 2019.   Results: We analyzed eighty-nine spinal SOLs during the study period. Spinal neoplasms encompassed the largest number accounting for 70.7% of total spinal SOLs. Majority were reported in the 20-40 years’ age group with predominant male preponderance except for universal phenomenon of female predominance in meningioma. Back pain was the most common clinical presentation. Among spinal neoplasms, NSTs comprising of schwannoma and neurofibroma, was the most common finding and spinal tuberculosis was the most common non-neoplastic SOL. Majority of benign spinal tumors were distributed in the intradural extra medullary location and involved thoracic vertebrae. Malignant tumors predominantly involved extradural location and were clustered along thoracic and lumbar vertebrae. Measure of agreement between radiological and histopathological diagnosis using kappa statistics revealed almost perfect agreement for extradural spinal SOLs and moderate agreement for intradural intramedullary and intradural extra medullary SOLs.   Conclusion: Comprehensive evaluation of spinal SOLs warrants multidisciplinary approach. Rapid advancements in radiology optimised diagnostic evaluation of non-neoplastic SOLs, however we conclude that histopathological evaluation is still the gold standard for diagnosis of primary spinal cord tumours and for planning the treatment and predicting prognosis.  

References

1. Kaye AH, Giles GG, Gonzales M. Primary central nervous system tumours in Australia: a profile of clinical practice from the Australian Brain Tumour Register. Aust N Z J Surg. 1993;63:33–38.
2. Helseth A, Mork SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg. 1989;71:842–845.
3. Cheang CM, Hwang SL, Hwong SL. An analysis of intraspinal tumors in south Taiwan. Kaohsiung J Med Sci. 1997; 13:229–236.
4. Preston-Martin S. Descriptive epidemiology of primary tumors of the spinal cord and spinal meninges in Los Angeles County, 1972-1985. Neuroepidemiology. 1990;9:106–111.
5. Shuangsh S, Panyatha R. Neural neoplasms in Thailand—study of 2,897 cases. Neurology. 1974;24:1127–1134.
6. Wen-qing H, Shi-ju Z, Qing-sheng T, Jian-qing H, Yu-xia L, Qing-zhong X, Zi-jun L, Wen-cui Z. Statistical analysis of central nervous system tumors in China. J Neurosurg. 1982;56:555–564.
7. Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: A review. Curr Neurol Neurosci Rep. 2011; 11: 320-328.
8. Parsa AT, Chi JH, Acosta Jr FL, et al. Intramedullary spinal cord tumors: Molecular insights and surgical innovation. Clin Neurosurg. 2005;52:76–84.
9. Pertuiset E, Beaudreuil J, Liote F, et al. Spinal tuberculosis in adults: a study of 103 cases in a developed country, 1980-1994. Medicine (Baltimore). 1999;78:309–320.
10. Kulchavenya E. Extrapulmonary tuberculosis: are statistical reports accurate? Ther Adv Infect Dis. 2014;2:61–70.
11. Yen HL, Lee RJ, Lin JW, Chen HJ: Multiple tuberculomas in the Brain and spinal cord: a case report. Spine. 2003; 28: 499-502.
12. Muthukumar N, Venkatesh G, Senthilbabu S, Rajbaskar R. Surgery for intramedullary tuberculoma of the spinal cord (report of 2 cases). Surg Neurol. 2006; 66: 69-74.
13. Louis DN, Ohgaki H, Wiestler OD, et al. WHO classification of tumours of the central nervous system. Revised 4th ed. Lyon, France: IARC, 2016.
14. Rajnish Kumar Arora and Raj Kumar, Spinal tumors: Trends from Northern India. Asian J Neurosurg. 2015 Oct-Dec; 10(4): 291–297.
15. Nitin M Gadgil, Chetan Sudhakar Chaudhari, Sangeeta R Margam, Mohd.Unzer Mohd. Umar Khan, Prashant Vijay Kumavat, Ganesh R Kshirsagar. A clinicopathological study of lesions of spinal cord and its coverings: A tertiary care hospital experience. Annals of Pathology and Laboratory Medicine.2006;03(03):A148-156.
16. Moein P, Behnamfar O, Farajzadegan Z. A 12-year old study on primary spinal cord tumors in Isfahan, Iran. J res med sci. 2013 Jan; 18(1): 17-21.
17. Lalitha VS, Dastur DK. Neoplasms of the central nervous system—histological types in 2237 cases. Indian J Cancer. 1980;17:102–106.
18. Schellinger KA, Propp JM, Villano JL, McCarthy BJ. Descriptive epidemiology of primary spinal cord tumors. J Neurooncol. 2008; 87:173–179.
19. Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG, Newton HB. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine. 2010;13:67–77.
20. Hirano K, Imagama S, Sato K, Kato F, Yukawa Y, Yoshihara H, Kamiya M,et al.. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J. 2012 Oct; 21(10): 2019-2026.
21. Gezen F, Kahraman S, Canakci Z, Beduk A. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976). 2000;25:727– 31.
22.Peker S, Cerci A, Ozgen S, et al. Spinal meningioma: evaluation of 41 patients. J Neurosurg Sci. 2005;49:7–11.
23. Jagadesh BK, Reddy S, Ponraj S, Murali GV, Govindappa CHV, Hanuman DS. Clinicopathological study of intradural extra medullary spinal cord tumors. Sch J Med Case Rep. 2014; 2(2): 108-111.
24. Suh YL, Koo H, Kim TS, Chi JG, Park SH, Khang SK, Choe G, Lee MC, Hong EK, Sohn YK, Chae YS, Kim DS, Huh GY, Lee SS, Lee YS. Tumors of the central nervous system in Korea—a multicenter study of 3221 cases. J Neurooncol. 2002;56:251–259.
25. Craciunas SC, Gorgan MR, Cirstea CM, Aschie M. Intramedullary Tumors - Clinical, Radiological and Histological Correlations. Romanian Neurosurgery 2011 18(2):1-16.
26. Prasad GL, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma: A report of two cases. Neurology India. 2012 May-Jun; 60(3): 333-335.
27. Adam Y, Benezech J, Blanquet A, Fuentes JM, Bousigue JY, Debono B et al.Intramedullary tumors. Results of a national investigation in private neurosurgery. Neurochirurgie 2010 Aug; 56(4):344-9.
28. Milano MT, Johnson MD, Sul J, Mohile NA, Korones DN, Okunieff P et al. Primary spinal cord glioma: a surveillance, epidemiology, and end results database study. J Neuro-oncol 2009 Nov: 1-10.
29. Srinivas DD Gubbala, Sridevi Mattaparti, Bhavani. Primary Intradural Extra medullary Extra-Osseous Ewing’s Sarcoma of Cervical Spine (C5-C7). Annals of Pathology and Laboratory Medicine. 2019;6(12):C123-127.
30. Thacker MM, Puri AI. Concurrent intramedullary and intracranial tuberculomas. J Postgrad Med 2004; 50: 107- 109.
31. Rachana Swapnil Binayke, Shantilal Mohanlalji Sisodia, Tushar Chintaman Joshi. Clinico Pathological Study of Parenchymal Lesions of Spinal Cord. Annals of Pathology and Laboratory Medicine.2018;05(12):A967-972
32. Odebode TO, Udoffa U, Nzeh D. Cervical myelomeningocele and hydrocephalus without neurological deficit: A Case Report. American-Eurasian Journal of Scientific Research 2007; 2 (1): 60-62.
Published
2020-09-25
Section
Original Article