Paragangliomas in the cauda equina region: clinicopathoradiologic findings in four cases

Abstract

Paragangliomas of the cauda equina are rare neuroendocrine tumors. Four cases of nonsecreting paraganglioma of the cauda equina, preoperatively misdiagnosed as neurinoma, are presented with an emphasis on the correlation between magnetic resonance imaging findings and pathological features. Although it is difficult to correctly diagnose paraganglioma preoperatively for intradural extramedullary tumors, especially in the cauda equina, paraganglioma should be included in differential diagnoses.

Lumbar intradural paragangliomas: report of two cases

“…Almost 200 cases of spinal PGs have been reported so far (1,5,29). The majority of these cases were reported to be located in the intradural space.…”

“…In 1972 Lerman et al reported a similar case and named it paraganglioma (13). Spinal paragangliomas comprise 3-4% of all spinal tumors, and about 200 cases of cauda equina PG have been reported in the literature (1,5,29,30).…”

“…Magnetic resonance imaging (MRI) is currently the best modality demonstrating details of cauda equina PGs (1,2,26,29). As in other cauda equina and conus medullaris tumors, surgery is the treatment of choice.…”

Neuronal and Mixed Neuronal-Glial Tumors of the Central Nervous System

“…And 174 cases reported prior to 2003 (202). Paragangliomas of the cauda equine region comprise 3.4% to 3.8% of all tumors affecting this region (203,204). Other spinal levels are involved far less often; 14 paragangliomas were reported in the thoracic region, most being extradural with an intravertebral and paraspinal component (205,206), and 2 tumors involved the cervical region (207,208).…”

“…The presence of ecstatic and dilated vessels and a low signal intensity rim ("cap sign") on T2-weighted images are considered diagnostically important feature. Plain radiographs are usually helpful, and show some scalloping of the vertebral bod y due to chronic bone compression (204,218). Figure 13 …”