Ghanchi Hammad, Hariri Omid R, Takayanagi Ariel, Li Gordon
Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
World Neurosurg. 2018 Sep;117:366-370. doi: 10.1016/j.wneu.2018.06.162. Epub 2018 Jul 20.
Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine.
A 40-year-old male with a past medical history of HIV and hepatitis B infection presented with a 2-month history of progressive back pain radiating to the left flank and thigh. Magnetic resonance imaging of the thoracic and lumbar spine with intravenous gadolinium contrast revealed 2 extramedullary masses in the left neural foramina of T6 and L1. The patient underwent laminectomy, which revealed that the 2 lesions were entirely extradural. Both lesions were resected, and the histological diagnosis for both lesions was meningioma, World Health Organization grade I.
Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.
单纯硬脊膜外脊膜瘤并不常见。由于其典型位于神经孔，常被误诊为神经鞘瘤、神经纤维瘤和硬脊膜外转移瘤。此外，免疫缺陷等合并症可能会掩盖诊断。我们报告一例人类免疫缺陷病毒（HIV）患者的硬脊膜外脊膜瘤病例。这是首例报道的在脊柱两个不同区域出现多发硬脊膜外脊膜瘤的病例。
一名40岁男性，有HIV和乙型肝炎感染病史，出现渐进性背痛2个月，放射至左侧胁腹和大腿。胸椎和腰椎磁共振成像静脉注射钆对比剂后显示T6和L1左侧神经孔有2个髓外肿块。患者接受了椎板切除术，结果显示这2个病变完全位于硬脊膜外。两个病变均被切除，组织学诊断均为世界卫生组织I级脊膜瘤。
我们对这名40岁患有艾滋病且因多发单纯硬脊膜外脊膜瘤出现神经根症状的男性患者的治疗经验强调了在神经孔肿瘤患者中考虑脊膜瘤作为可能诊断的重要性。此外，对于有脊柱病变和HIV病史的患者应进行广泛的鉴别诊断，包括与免疫缺陷相关的疾病和无关疾病。
