• Journal of Korean Neurosurgical Society
• /
• 제48권3호
• /
• pp.276-280
• /
• 2010

Liposarcomas are malignant tumors of the soft tissue, with myxoid liposarcoma being the second most common subtype, tending to occur in the limbs, particularly in the thighs. Myxoid liposarcomas have an intermediate prognosis between well-differentiated and pleomorphic tumors. Spinal metastasis is usual but intradural involvement is extremely rare. We present an unusual case of a multicentric myxoid liposarcoma with intradural involvement. A 41-year-old woman complained of tingling sensation on her left arm. Radiological evaluation revealed multiple masses in her cervical spine, abdominal wall, liver, heart and right thigh, all of which were resected. She was histologically diagnosed with small round cell myxoid sarcoma and underwent adjuvant chemotherapy. However, magnetic resonance imaging analysis after 1 year revealed a large metastatic mass with bony invasion at the C6-T1 level. This mass consisted of extradural and intradural components causing severe compression of the spinal cord. She underwent resection via a posterior facetectomy of C6-7 and an anterior C7 corpectomy. However, the patient died of multiple metastases 18 months after the first diagnosis.

• Radiation Oncology Journal
• /
• 제9권2호
• /
• pp.177-184
• /
• 1991

1984년 12월 부터 1990년 2월까지 인제대학교 의과대학 부산 백병원 치료방사선과에서 송과선 및 뇌하수체상부에 위치한 종양으로 진단받은 16명의 환자에 대하여 외부 방사선 조사를 시행하였다. 조직학적 진단은 5명에서 가능했고 나머지 11명의 환자는 조직학적 진단없이 치료를 시작하였다. 방사선조사는 전뇌-척수부위(6명), 전뇌부위(9명), 종양부위(1명)로 시행하였다. 생명표에 의거한 환자의 생존율은 $71\%$였다. 조직학적 진단이 가능했던 3명, 종양 marker정상소견을 보인 7명 그리고 beta-HCG 증가를 보인 환자들은 방사선치료에 좋은 반응을 보였으나, AFP의 증가를 보인 환자에서는 방사선치료에 대한 반응이 좋지 않았다. 척수전이는 AFP증가를 보인 2예에서 관찰되었다. : 1명은 예방적 척추조사를 받았으나, 다른 한명은 받지 않았다. 이상의 고찰을 통하여 AFP의 증가를 보이는 환자에서는 방사선치료 외에 보다 적극적인 치료가 간구되어야 하며, 이런 환자에서는 조직학적 진단 없이 방사선 치료를 시작할 수 있다. 그리고 예방적 목적으로 척수조사를 하는 것은 뇌척수액 세포검사의 양성, 뇌 척수막으로의 전이, 뇌실 침범, 조직학적으로 입증된 생식세포종일 경우에는 고려할 수 있다.

• Journal of Korean Neurosurgical Society
• /
• 제53권3호
• /
• pp.190-193
• /
• 2013

A malignant peripheral nerve sheath tumor (MPNST) is a type of sarcoma that arises from peripheral nerves or cells of the associated nerve sheath. This tumor most commonly metastasizes to the lung and metastases to the spinal cord and brain are very rare. We describe a case of young patient with spinal cord and brain metastases resulting from MPNST. An 18-year-old man presented with a 6-month history of low back pain and radiating pain to his anterior thigh. Magnetic resonance imaging showed a paraspinal mass that extended from the central space of L2 to right psoas muscle through the right L2-3 foraminal space. The patient underwent surgery and the result of the histopathologic study was diagnostic for MPNST. Six months after surgery, follow-up images revealed multiple spinal cord and brain metastases. The patient was managed with chemotherapy, but died several months later. Despite complete surgical excision, the MPNST progressed rapidly and aggressively. Thus, patients with MPNST should be followed carefully to identify local recurrence or metastasis as early as possible.

• 대한세포병리학회지
• /
• 제10권1호
• /
• pp.73-78
• /
• 1999

Myxopapillary ependymoma generally arise in the conus medullaris and filum terminale of adult spinal cord. These tumors are readily recognized due to unique histopathologic features, however, their cytologic features are not well described. When only a tiny sample is obtained, cytologic examination using crush preparation may be a useful diagnostic tool to help appropriate intraoperative diagnosis. We present the crush cytologic features of myxopapillary ependymoma arising in thoracic and lumbar spinal cord of a 13-year-old boy. The patient had complained of paraparesis and back pain for 1 month. The MRI image revealed a relatively well demarcated intramedullary mass in T11-L1 levels. Crush preparation for cytology were peformed by biopsy material. Crush cytologic findings revealed high cellularity and small sized branching papillary clusters on fibrillary or mucinous background. The tumor cells had uniform round or elongated nuclei. The cytoplasmic process of tumor cells were attached to the vascular wall. Between the tumor cells and vascular walls, the perivascular collar of globoid acellular stroma with metachromatic reaction on toluidin blue stain was noted. The crush preparation of myxopapillary ependymoma is considered as a simple and highly accurate diagnostic tool for differentiation from other intramedullary neoplasms of central nervous system.

• Journal of Korean Neurosurgical Society
• /
• 제50권5호
• /
• pp.468-471
• /
• 2011

Mesenchymal chondrosarcomas are rare malignant tumors of the bone and soft tissue. Spinal mesenchymal chondrosarcomas are even rarer and, to the best of our knowledge those that are concomitantly located in the intradural and extradural regions, have never been reported. We report a case of a 25-year-old man with back pain and bilateral progressive weakness of the lower extremities. Magnetic resonance imaging revealed a markedly enhanced dumbbell-shaped mass at the T7 level. The lesion was intradurally located at the left side of the spinal cord, and extended extradurally to the extraforminal space through the T7-8 intervertebral foramen. The tumor was completely excised through a posterior approach. Microscopic examination and immunohistochemical studies confirmed mesenchymal chondrosarcoma. Postoperative radiation therapy and chemotherapy were also performed to prevent local recurrence and metastasis. The patient has been symptom-free for two years after surgery. Herein, we reviewed and discussed the clinical characteristics, treatments, and outcomes of primary intraspinal mesenchymal chondrosarcomas in the literature.

• Journal of Korean Neurosurgical Society
• /
• 제66권6호
• /
• pp.632-641
• /
• 2023

Central nervous system tumors are identified as tumors of the brain and spinal cord. The associated morbidity and mortality of cerebrospinal tumors are disproportionately high compared to other malignancies. While minimally invasive techniques have initiated a revolution in neurosurgery, artificial intelligence (AI) is expediting it. Our study aims to analyze AI's role in the neurosurgical management of cerebrospinal tumors. We conducted a scoping review using the Arksey and O'Malley framework. Upon screening, data extraction and analysis were focused on exploring all potential implications of AI, classification of these implications in the management of cerebrospinal tumors. AI has enhanced the precision of diagnosis of these tumors, enables surgeons to excise the tumor margins completely, thereby reducing the risk of recurrence, and helps to make a more accurate prediction of the patient's prognosis than the conventional methods. AI also offers real-time training to neurosurgeons using virtual and 3D simulation, thereby increasing their confidence and skills during procedures. In addition, robotics is integrated into neurosurgery and identified to increase patient outcomes by making surgery less invasive. AI, including machine learning, is rigorously considered for its applications in the neurosurgical management of cerebrospinal tumors. This field requires further research focused on areas clinically essential in improving the outcome that is also economically feasible for clinical use. The authors suggest that data analysts and neurosurgeons collaborate to explore the full potential of AI.

• Journal of Korean Neurosurgical Society
• /
• 제59권2호
• /
• pp.83-90
• /
• 2016

Ependymomas occur in both the brain and spine. The prognosis of these tumors sometimes differs for different locations. The genetic landscape of ependymoma is very heterogeneous despite the similarity of histopathologic findings. In this review, we describe the genetic differences between spinal ependymomas and their intracranial counterparts to better understand their prognosis. From the literature review, many studies have reported that spinal cord ependymoma might be associated with NF2 mutation, NEFL overexpression, Merlin loss, and 9q gain. In myxopapillary ependymoma, NEFL and HOXB13 overexpression were reported to be associated. Prior studies have identified HIC-1 methylation, 4.1B deletion, and 4.1R loss as common features in intracranial ependymoma. Supratentorial ependymoma is usually characterized by NOTCH-1 mutation and p75 expression. TNC mutation, no hypermethylation of RASSF1A, and GFAP/NeuN expression may be diagnostic clues of posterior fossa ependymoma. Although MEN1, TP53, and PTEN mutations are rarely reported in ependymoma, they may be related to a poor prognosis, such as recurrence or metastasis. Spinal ependymoma has been found to be quite different from intracranial ependymoma in genetic studies, and the favorable prognosis in spinal ependymoma may be the result of the genetic differences. A more detailed understanding of these various genetic aberrations may enable the identification of more specific prognostic markers as well as the development of customized targeted therapies.

• 대한영상의학회지
• /
• 제83권4호
• /
• pp.938-944
• /
• 2022

표피양 낭종은 척수에 매우 드물게 발생하는 양성 병변이다. 선천적 또는 후천적으로 생길 수 있는데, 후천적 표피양 낭종은 주로 요천추부 높이에서 발생한다. 척수 자극기 삽입과 관련하여 표피양 낭종이 생긴 증례는 보고된 바 없다. 저자들은 척수 자극기 삽입술을 받았던 50세 여자 환자에서 표피양 낭종이 척수 자극기 끝의 위치와 인접한 흉추부 경막 내에 발생한 드문 증례를 경험하였기에 MRI 소견 및 문헌 고찰과 함께 보고하고자 한다.

• Investigative Magnetic Resonance Imaging
• /
• 제17권1호
• /
• pp.8-18
• /
• 2013

목적: 척추전이의 자기공명영상 소견들 중 특정 원발성 암에 특이적인 소견들이 있는지 알아보고자 한다. 대상과 방법: 본 연구에서는 자기공명영상을 시행한 총 169개의 척추전이암 병변들 (56개는 폐암, 29개는 유방암, 20개는 대장암, 17개는 간세포암, 그리고 47개는 위암으로부터 기원)을 후향적으로 분석하였다. 각 병변의 크기, 위치, 침범 정도, 신호강도, 경계, 조영증강 양상, 그리고 골융해/골경화 특성들을 분석하여 원발성 암의 기원에 따라 차이가 있는지 보았다. 결과: 간세포암의 전이 병변들은 대장암을 제외하고는 (P=0.268) 다른 암에 비하여 크기가 유의하게 컸다 (P < 0.05). 경계가 좋은 병변은 폐암과 유방암에서 기원한 경우에서 더 흔히 관찰되었다 (P < 0.01). 간세포암을 제외한 모든 암에서 전이를 할 때 척추의 후부요소보다 척추체를 더 자주 침범하였다(P < 0.02). 대장암과 간세포암은 골외 침범을 더 자주 보였으나 통계학적 의미는 없었다 (P > 0.05). 간세포암과 위암의 전이병변들은 특징적인 조영증강 양상을 보였다. 결론: 일부 자기공명영상 소견들은 척추전이 병변이 어떤 원발성 암에서 기원한 것이지 예측하는 데 도움이 될 수 있다.

• Journal of Korean Neurosurgical Society
• /
• 제52권4호
• /
• pp.410-413
• /
• 2012

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.