Singh Naorem Gopendro, Sarkar Chitra, Sharma Mehar Chand, Garg Ajay, Gaikwad Shailesh B, Kale Shashank S, Mehta Vir Singh
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Brain Tumor Pathol. 2005;22(1):15-20. doi: 10.1007/s10014-004-0170-1.
The authors report seven uncommon cases of paraganglioma of the cauda equina region with reference to their clinical, radiological, and pathological findings. The common presenting symptoms in all the patients were low backache with radiation to both thighs, sensory and motor deficits in four patients, and urinary retention in three patients. One patient presented with ataxia and superficial sidrosis of the brain. Magnetic resonance imaging (MRI) revealed well-circumscribed lesions that were isointense on T1- and T2-weighted images with flow voids. All the tumors were well circumscribed and could be excised completely; however, one recurred. Histological examination revealed a classic "zellballen" pattern in four tumors. Two mimicked ependymoma but were confirmed as paraganglioma by immunohistochemistry. MIB-1 LI was low in all the tumors. Thus, there were no identifying clinical or radiological features that helped in differentiating paraganglioma from other common tumors, such as ependymoma or neurinoma, in this region, and preoperative diagnosis was not possible in any of the cases. Morphologic features and immunohistochemical analysis proved to be the mainstay of arriving at a correct diagnosis. This report highlights the significance of important morphologic features and immunohistochemistry in the diagnosis of paraganglioma at this unusual site.
作者报告了7例马尾神经节瘤罕见病例，并阐述了其临床、放射学及病理学表现。所有患者的常见症状为下背部疼痛并向双侧大腿放射，4例患者有感觉和运动功能障碍，3例患者有尿潴留。1例患者表现为共济失调和脑部多汗。磁共振成像（MRI）显示边界清晰的病变，在T1加权像和T2加权像上呈等信号，伴有流空现象。所有肿瘤边界清晰，均可完整切除；然而，有1例复发。组织学检查显示，4例肿瘤呈现典型的“细胞巢”模式。2例类似室管膜瘤，但免疫组化证实为神经节瘤。所有肿瘤的MIB-1标记指数均较低。因此，在该区域，没有可用于鉴别神经节瘤与其他常见肿瘤（如室管膜瘤或神经鞘瘤）的特征性临床或放射学表现，所有病例均无法进行术前诊断。形态学特征和免疫组化分析是做出正确诊断的主要依据。本报告强调了重要的形态学特征和免疫组化在该罕见部位神经节瘤诊断中的重要性。
