Yoshimura Kazuhiro, Sasaki Manabu, Kojima Masaru, Tsuruzono Kouichirou, Matsumoto Katsumi, Wakayama Akatsuki, Yoshimine Toshiki
Department of Neurosurgery, Osaka Neurological Institute, 2-6-23, Shonai, Takara-machi, Toyonaka, Osaka, 561-0836 Japan.
Department of Neurosurgery and Spine Surgery, Iseikai Hospital, 6-2-25, Sugawara, Hgashiyodogawa-ku, Osaka, 533-0022, Osaka, Japan.
NMC Case Rep J. 2016 Sep 7;3(4):111-114. doi: 10.2176/nmccrj.cr.2015-0314. eCollection 2016 Oct.
Spinal intradural extramedullary inflammatory pseudotumor (IPT) is an extremely rare entity. Spontaneous shrinking of a spinal IPT has never been reported. A case of an IPT of the cauda equina that regressed spontaneously is presented. A 78-year-old woman presented with hypoesthesia of both lower legs in the L4 nerve root distribution and motor weakness of the right leg. Preoperative CT myelography and MRI showed two tumor-like lesions located at T12-L1 and L2-3. The lesion at the T12-L1 level appeared to encase several nerve roots. The preoperative diagnosis was ependymoma, schwannoma, or malignant lymphoma. The tumors were biopsied. In the operation, the lesion turned out to consist of swollen and adherent nerve roots. On histopathological examination of the biopsied nerve roots, they were diagnosed as IPT. The patient's symptoms improved gradually without any treatment after the operation. The IPTs regressed on the postoperative MR images and disappeared at one year. This is the first report of spontaneous regression of an IPT in the spinal region. IPT should be considered in the differential diagnosis of a tumor that appears to involve several nerve roots on preoperative imaging, but surgery is necessary for diagnosis. Complete resection is not absolutely required if an intraoperative pathological diagnosis of the frozen section reveals IPT.
脊髓硬膜内髓外炎性假瘤（IPT）是一种极其罕见的疾病。脊髓IPT自发缩小的情况此前从未有过报道。本文报告了一例马尾神经IPT自发消退的病例。一名78岁女性患者，表现为双侧小腿L4神经根分布区感觉减退及右腿肌力减弱。术前CT脊髓造影和MRI显示T12-L1和L2-3水平有两个肿瘤样病变。T12-L1水平的病变似乎包绕了几根神经根。术前诊断为室管膜瘤、神经鞘瘤或恶性淋巴瘤。对肿瘤进行了活检。手术中发现病变由肿胀且粘连的神经根组成。对活检的神经根进行组织病理学检查，诊断为IPT。术后患者未经任何治疗症状逐渐改善。术后MRI图像显示IPT消退，一年后消失。这是脊髓区域IPT自发消退的首例报告。对于术前影像学显示似乎累及几根神经根的肿瘤，鉴别诊断时应考虑IPT，但诊断仍需手术。如果术中冰冻切片病理诊断为IPT，则不一定需要完全切除。
