primary tumors of the spine (AO)

Question 1

what are the benign tumors of the spine?

Answer 1

• osteoid osteoma
• osteoblastoma
• Giant cell tumors
• aneurysmal bone cyst
• hemangioma

Question 2

malignant tumors of the spine

Answer 2

• chondrosarcoma
• osteosarcoma
• Ewings sarcoma
• Chordoma

Question 3

what is the most common primary spine tumor?

Answer 3

vertebral hemangioma

Question 4

Spinal tumors are referred to by their location in the spine. What are the three location?

Answer 4

• intradural-extramedullary
• intramedullary
• extradural.

Question 5

How many % of spinal tumors are extradural?

Answer 5

55%

Question 6

How many % of spinal tumors are intradural-extramedullar?

Answer 6

40%

Question 7

What is the most common intradural-extramedullary tumor?

Answer 7

• meningiomas
• schwannomas and neurofibromas
• filum terminale ependymomas

Question 8

how many % of the spinal tumors are intramedullary?

Answer 8

5%

Question 9

What are the two most common intramedullary tumors of the spinal cord?

Answer 9

• Ependymomas
• Astrocytomas

Question 10

Where in the spine is Astrocytomas usually found?

Answer 10

1. Thoracic
2. cervical

Question 11

Where are ependymomas most often located in the spine according to EANS homepage…..

Answer 11

In the filum.

Question 12

Which is the most common intramedullary neoplasm in adults?

Answer 12

ependymoma comprising 60% of all glial spinal cord tumors.

Question 13

Which is the most common intrmedullary spinal neoplasm in pediatrics?

Question 14

Which is the second most common intramedullary neoplasm in pediatric pop?

Answer 14

Ependymoma

Question 15

What genetic disease is associated with spinal ependymomas?

Answer 15

NF 2

Question 16

Which are the most common clinical signs of intramedullary ependymomas?

Answer 16

• pain, * weakness, * sensory changes

Question 17

Where, inside of the medulla are ependymomas usually located, and therefore explain a frequent presentation symptom?

Answer 17

They are centrally located and proximal to the spinothalamic tract, which explains frequent presentation w sensory symptoms.

Question 18

What was thought and what is truth about the cell-pathology of ependymomas?

Answer 18

They were thought to arise from ependymal cells lining the central canal.
They ACTUALLY arise from progenitor cells or radial glia-like stem cells.

Question 19

Which is the classical microscpopic finding of spinal ependymomas?

Answer 19

Perivascular pseudorosettes.

Question 20

What WHO grade is the usual for spinal ependymoma?

Answer 20

grade 2

Question 21

In the 5th WHO classification a new group of previous ependymomas that are grade 5, very aggressive, is found. What is special w this group?

Answer 21

They have MYCN-amplification.

Question 22

Where are the most common sites for spinal ependymomas according to radiopedia?

Answer 22

44% cervical
23% cervical extending to thoracic
26% thoracic.

Question 23

MRI is the modality of choice to identify ependymoma. What are the general findings to look for?

Answer 23

• widened spinal cord
• well circumscribed
• tumoral cysts in 22%, non-tumoral cysts in 62%
• syringohydromyelia in 9-50%
• in contrast to intracranial ependymomas, calcification is UNcommon.
• Average length of 4 vertebral body segments.

Question 24

Describe T1, T2 and T2 Gd for ependymomas

Answer 24

T1- isointense to hypointense
T2- hyperintense
-peritumoral edema in 60%
-“cap sign” in 20-33%
T1gd - virtually all enhance strongly, somewhat inhomogenously.

Question 25

What is a "cap sign"?

Answer 25

its a hypointense hemosiderin rim.

Question 26

Is a "cap sign" pathognomonic for ependymoma?

Answer 26

No. its suggestive. It may also occur in hemangioblastoma and paraganglioma.

Question 27

How does ependymomas grow?

Answer 27

They grow slow. Compress surrounding tissue, dont infiltrate. Almost always leaving a cleavage plane.

Question 28

If not MYCN amplificated, what is the treatment and prognosis of spinal ependymomas?

Answer 28

Curative excision = 50% 5 y survival then 85%, recurrence rare. Non-complete resection; survival rate 57%.

Question 29

Which are the main differential diagnostic options on MRI?

Answer 29

no1= spinal astrocytoma. (*spinal cavernous malformation *diffuse midline glioma H3 K27 altered)

Question 30

How to differentiate spinal astrocytoma and spinal ependymoma on MRI?

Answer 30

astrocytoma - *eccentric location in the spinal canal. * ill defined * hemorrhage uncommon * involvement of the entire cod diameter and longer cord segements favours astrocytoma. * patchy irregular contrast enhancement * bone changes are infrequent.

Question 31

How is spinal cavernous malformations seen on MRI in the spine?

Answer 31

* No enhancement * complete hemosiderin ring.

Question 32

What is the second mot common spinal cord tumor in adulats and first in pediatric pop?

Answer 32

Spinal astrocytoma. 40% of intramedullary tumors in adults. 60% of intramedullary tumors in children.

Question 33

Spinal astrocytoma is associated to a genetic syndrome. What?

Answer 33

NF 1

Question 34

What specific type of spinal astrocytoma is more often associated to NF1?

Answer 34

high-grade astrocytoma with piloid features.

Question 35

Common presentation signs clinically for spinal astrocytomas?

Answer 35

Pain, sensory (53%), weakness (41%)

Question 36

What type of cells does both intracranial and spinal astrocytomas arise from?

Answer 36

Astrocytic glial cells

Question 37

Histologic grade of spinal astrocytoma differ from the brain. how?

Answer 37

Its usually lower grade. both for children and adults.

Question 38

How many % are low grade of astrocytomas in the spine in adults and peds?

Answer 38

75% adults 80% peds.

Question 39

How are spinal astrocytomas growing?

Answer 39

They are hypercellular and do not have a capsule nor a cleavage plane. Overall 60% (mostly high grade) spread leptomeningealy.

Question 40

What is the average length of an spinal astrocytoma?

Answer 40

4-7 vertebral body segments.

Question 41

Where in the spine are astrocytoma located?

Answer 41

67% thoracic 49% cervical and many both.

Question 42

It is more common that the entore cord is involved in children than in adults. What is that called?

Answer 42

Holocord presentation

Question 43

Location that is rare in astrocytoma and somewhat more common in especially myxopapillary ependymomas

Answer 43

conus medullaris 3% filum terminale -almost enevr

Question 44

What is the treatment of astrocytomas?

Answer 44

Surgical excision is usually the treatment of choice. However almost always histologically incomplete.

Question 45

Spinal cord astrocytomas differ a lot in prognosis between adults and children. How and why?

Answer 45

Children tend to be associated w good prognosis. behave like grade I cerebellar pilocytic astrocyomas and displace neural tissue rather than infiltrating it.

Question 46

1st differential diagnosis to AStrocytoma and what might help differentiating?

Answer 46

spinal EPENDYMOMA. that is * more common in adults * scoliosis and bony remodelling is more common in ependymoma * central location in the spinal canal * well circumscribed * 20% hemosiderin capping * more homogenous contrast enhancement More frequent and more prominent cysts (intratumoral and polar)