GPR: 2019 - Week 48

From MGH Learn Pathology

Clinical history

35 year old male with pain radiating to lower extremities with intradural mass at L2-L3.


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Myxopapillary Ependymoma
  • Typical sausage appearance
  • Tan grey color
  • Lobulated/ variegated appearance on cut surface
  • Occur most often in the cauda equina and filum terminale
  • Cuboidal to elongated tumor cells are radially arranged around fibrovascular cores as papillae
  • Can lack papillary structure and have cells in sheets or fascicles
  • Low mitotic activity
  • Usually present in patients aged 20-40 years old
  • Associated with syringomyelia
  • Good prognosis with mean survival of 19 years
 

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Schwannoma

  • Well circumscribed mass
  • Often eccentric growth off of nerve
  • Tan-yellow cut surface
  • Most prominent feature is mixture of cellular and hypo-cellular Antoni A and B regions
  • Palisading nuclei “Verocay bodies”
  • S100+ in all variants
  • Spinal schwannomas comprise 25% of intraspinal tumors
  • Complete resection is curative
  • Arise predominately from sensory nerve roots
 

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Meningioma

  • Well circumscribed nodule
  • Broad base with dural attachment
  • Can have a gritty texture especially in psammomatous spinal tumors
  • Wide range of histologic patterns
  • Meningothelial meningiomas show sheets and lobules of oval cells that form whorling patterns
  • 15% of meningiomas are intraspinal
  • 10:1 female: male for intraspinal meningioma
  • Generally good prognosis
 


  • Dr. Sam Champion
  • Dr. Maria Martinez-Lage

This week's Gross Pathology Roundup was presented by Leif Timothy Helland, MD on Mon, Nov 25, 2019.