J Korean Soc Radiol.  2019 Nov;80(6):1235-1240. 10.3348/jksr.2019.80.6.1235.

Spinal Epidural En Plaque Meningioma Misdiagnosed as Lymphoma: A Case Report

Affiliations
  • 1Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea. raceryo@naver.com
  • 2Department of Pathology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea.

Abstract

Spinal meningiomas in the epidural location are rare, accounting only 2.5% to 3.5% of all spinal meningiomas. The diagnosis of spinal epidural meningiomas, solely based on imaging findings, can be difficult. They are easily mistaken for metastatic tumors or lymphomas, especially, meningiomas of the enplaque type. Misdiagnosis of meningiomas can affect the extent of surgery and patients' outcome; hence, a careful diagnosis is needed. We report a case of pathologically confirmed epidural enplaque meningioma in the cervical spine with neural foraminal extension. Additionally, its clinical implications, radiologic features, and diagnostic difficulties are discussed.


MeSH Terms

Diagnosis
Diagnostic Errors
Epidural Neoplasms
Lymphoma*
Magnetic Resonance Imaging
Meningioma*
Spine

Figure

  • Fig. 1 An en plaque epidural meningioma at the C3–4 level in a 79-year-old woman. A, B. Anteroposterior radiograph (A) and axial postcontrast CT (B) show subtly enhanced spinal and extraspinal mass with neural foraminal widening of C3–4 (arrow). C–E. Axial (C) and sagittal (D) T2-weighted images indicate the epidural mass encircling the spinal cord as a half ring with intermediate high signal intensity to the spinal cord (arrow). Axial (C) and sagittal (E) postcontrast T1-weighted image shows the homogeneously enhanced epidural mass extending to the left neural foramen of the C3–4. F. Histologically, the tumor cells are uniform, similar in appearance to normal arachnoid cells with ovoid nuclei showing lobular to fascicular arrangements with occasional presence of psammoma bodies and collagenous matrix (hematoxylin and eosin stain, × 200).


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