A Rare Case of Calcifying Pseudoneoplasms of the Neural Axis in Lumbar Spine

Abstract

Calcified pseudoneoplasm of the neural axis (CAPNON) is a very rare, non-neoplastic, calcified pathological entity occurring anywhere in the central nervous system (CNS). Overall, less than 100 cases were reported, of which less than 50% were from the spine. We present a case of a 53-year-old lady with a history of L4–L5 radiculopathy, known case of rheumatoid arthritis, and with no previous history of trauma, tumor or infection. MRI showed calcified intradural mass, extending into the right lateral recess, which was isointense on T1- and T2-weighted sequences. Fenestration on right side along with complete resection of the lesion was done. Mass was found adherent around the dura, extending in to right L5 nerve root foramen, and histopathological examination confirmed the diagnosis of CAPNON. At 6 months follow-up, the patient is pain-free with no radicular symptoms. This entity should be taken in as differential in cases of calcified intraspinal and intracranial lesions. Surgical resection is the treatment of choice.

Lumbar Calcifying Pseudoneoplasm as a Rare Cause of Cauda Equina Syndrome: A Case Report

“…It is difficult to suspect and diagnose the disease with only conventional imaging workup such as MRI, computed tomography (CT) scans and X-rays. The tumor usually displays partial calcifications on CT scans and on the MRI it usually shows a well-defined hypointense lesion in T1 and T2 weighted images along with limited hyperintensity after contrast enhancement T1 weighted imaging 13,15,20) . Due to these non-specific characteristics of the tumor, it is crucial for physicians to rule out other more common possible disease entities.…”

“…In the case presented in this study it showed similar results where it showed hyalinized leiomyoma (positive for smooth muscle markers, SMA, desmin, negative for the expression of factor XIII); Inflammatory myofibroblastic tumor (negative for SMA expression and only sporadically positive for Keratin and desmin expression, while always positive for the expression of factor XIIIa and ALK). 4) 1993 Lumbar None Improved Mayr et al 15) 2000 Cervical and thoracic None Improved Liccardo et al 12) 2003 Dorsal None Improved Aiken et al 1) 2009 Dorsal None Not described Mahapatra et al 16) 2010 Lumber None Improved Naidu et al 17) 2012 Lumbar None Improved Nathoo et al 18) 2012 Lumbar None Improved Stienen et al 19) 2013 Lumber None Improved Kocovski et al 11) 2015 Lumbar Not described Not described Lopes et al 13) 2016 Lumbar None Improved García Duque et al 5) 2016 Cervical, dorsal, and lumbar None Improved Gauden et al 6) 2019 Cervical None Improved Ho et al 8) 2020 Cervical, dorsal, and lumbar None Variable Ravi et al 20) 2022 Lumbar None Improved…”