Contributed by Anca Florea, MD and Geoffrey Murdoch, MD, PhD
The patient was a 79 year old female presenting with a complaint of severe low back pain with radiation into the sacral area.
An MRI of the spine was performed and it showed an intradural extramedullary contrast enhancing mass with a small central area of hemorrhage, located at the level of the L2, within the central thecal sac and circumferentially displacing the cauda equina nerve roots.
A multilevel lumbar laminectomy for resection of tumor was performed.
Microscopic sections show a partially encapsulated neoplastic proliferation of monomorphic round to oval glial cells focally forming perivascular pseudorosettes. The tumor cells are radially arranged in vague papillary structures around markedly sclerotic vascularized stromal cores. Mild pleomorphism is noted. Areas of mucoid/myxoid degeneration are focally present throughout the tumor. A central focus of necrosis is noted. No mitoses, pleomorphic cellular features, proliferation of vascular spaces or necrosis were seen.
The tumor cells were diffusely positive for GFAP, vimentin and CD 56. There was focal cytoplasmic and dot-like staining for EMA . S100 immunohistochemical stain was positive in a subset of tumor cells . Inhibin, CAM5.2 and CD10 were negative in the tumor.