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 »  Introduction
 »  Case report
 »  Discussion
 »  References

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Year : 2001  |  Volume : 49  |  Issue : 1  |  Page : 97-9

Extramedullary astrocytoma of conus region : a short report.

Command Hospital (NC), C/O 56 APO.

Correspondence Address:
Command Hospital (NC), C/O 56 APO.

  »  Abstract

A 55 year old man presented with features of cauda equina syndrome. Magnetic resonance imaging (MRI) showed a well demarcated intradural extramedullary tumour at L2 vertebra. At surgery it was found to be well encapsulated and had no attachment to spinal cord or root. Histopathology including immunohistochemistry confirmed it to be a low grade astrocytoma.

How to cite this article:
Singh P, Singh A, Rajaram T, Sabhikhi A K. Extramedullary astrocytoma of conus region : a short report. Neurol India 2001;49:97

How to cite this URL:
Singh P, Singh A, Rajaram T, Sabhikhi A K. Extramedullary astrocytoma of conus region : a short report. Neurol India [serial online] 2001 [cited 2023 Mar 29];49:97. Available from: https://www.neurologyindia.com/text.asp?2001/49/1/97/1288

   »   Introduction Top

Astrocytomas are usually intramedullary tumours. At
times few of them may have an extramedullary
component.[1] However, purely extramedullary
astrocytomas are extremely rare. Such a tumour in an
adult, confirmed on immunohistochemistry, is

   »   Case report Top

A 64 year old man presented with insidious onset
numbness and weakness of left lower limb of one year
duration which progressed to involve the right lower
limb 6 months later. One month prior to admission he
had to strian to pass urine. Clinically he had wasting
of left thigh and calf muscles. The power in left hip
flexures and knee extensors was 3/5. Ankle
dorsiflexors, plantar flexors, knee flexors, hip
extensors and in all the muscle groups of right lower
limb was 4/5. There was hypoaesthesia in left L2 to S4
dermatomes. Left knee and ankle jerks were absent
and the right sided were markedly diminished. Rest of
the examination was unremarkable. Haematological
and biochemical tests were normal. Plain X-ray of
lumbar spine was also normal. A magnetic resonance
imaging (MRI) study of lumbar spine revealed a well
demarcated intradural mass at L2, lying to the left of
conus. It was isointense to the conus in T1WI [Figure - 1]
and isointense to CSF in T2WI. L1 to L3 laminectomy
was performed. On opening the dura the tumour was
found to be of greyish white in colour, well
encapsulated, pushing cauda equina roots to right and
left. It had no attachment to conus or dura but was
attached to surrounding roots on left side through fine
arachnoidal adhesions but did not have origin from
any of the roots. It was soft suckable and nearly
avascular. After intratumoural decompression, total
removal was done. Post operative period was
uneventful and he gradually improved neurologically.
Histopathology revealed fibrillary astrocytes,
microcystic areas and absence of mitotic activity on
haematoxylin and eosin preparation [Figure - 2] and
positivity to glial fibrillary acid i.e. protein on
immunohistochemistry [Figure - 3].
Correspondance to : Dr. Prakash Singh, Classified Specialist
Neurosurgery, Command Hospital (NC), C/O 56 APO.

   »   Discussion Top

The development of glial neoplasms in the
leptomeninges, independently of an intramedullary
gliomas has been reported.[2],[3],[4] It has been postulated
that such tumours arise from glial heterotopias.[4]
Wolback first drew attention to the presence of glial
heterotopias in 1907.[5] Bailey was first to report
extramedullary parietal glioma and suggested its
possible origin from such heterotopias.2 Cushing and
Eisenhardt reported first case of spinal extramedullary
intradural glioma which looked like a meningioma but
on histopathology was found to be astrocytomas.[3]
Cooper et al reported 15 cases of extramedullary
gliomas; 9 of these were intradural of which 5 were
astrocytoma, two were in thoracolumbar region. Our
case belongs to this subgroup.
Lack of apparent attachment to the cord or roots and
presence of a well formed capsule has been
highlighted by Cooper et al.[4] It is though to be of pial
origion. However despite apparent lack of attachment
to surrounding structures these tumours are easily
mistaken for a nerve sheat tumour or a meningioma at
surgery. It is on histopathology that diagnosis is
established. In our case, the diagnosis was clear on
light microscopy and was further confirmed beyond
doubt on immunohistochemistry. MRI in our case had
excluded any intramedullary component. Complete
encapsulation of tumour as seen during surgery also
ruled out any such possibility. The need for post
operative MRI was stressed by Dinakar et al[6] but in
our case, there was no doubt on preoperative MRI and
on surgery. Since total removal along with capsule of
the tumour was done in the present case, astrocytoma
was labelled 'low grade', and the patient was not
given any radiotherapy.

  »   References Top

1.Venkataramana NK, Kolluri VRS, Narayanaswamy KS et al : Extrophytic gliomas of the spinal cord. Acta Neurochir(Wein) 1990; 107 : 44-46.  Back to cited text no. 1    
2.Bailey OT : Relation of glioma of leptomeninges to neurological nests. Report of a case of astrocytoma of the leptomeninges. Archieves of Pathology (Chicago) 1936; 21: 584-600.  Back to cited text no. 2    
3.Cushing H, Eisenhardt L : Meningiomas, their classification, regional behaviour, life history and sugical results. Charles C Thomas. Springfield 1938; 785.  Back to cited text no. 3    
4.Cooper IS, Craig WM, Kermohan JW : Tumours of spinal cord primary extramedullary gliomas. Surgery, Gynecology and Obstertrics 1951; 92 : 183-190.  Back to cited text no. 4    
5.Wilkinson HA, Mark VH : Thoracic extramedullary astrocytoma. J Neurosurg 1968; 28 : 504-508.  Back to cited text no. 5    
6.Dinakar I, SUndaram C, Ratnakar KS et al : Extramedullary glioma of cervicodorsal spinal cord : A case report. Surg Neurol 1994; 41 : 235-237.  Back to cited text no. 6    


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