Brain Pathology Case of the Month - November 2000

Contributed by A.K. Bruecks1, R.J.B. Macaulay2, K.A. Tong3, and G. Goplen4
1Department of Pathology and Laboratory Medicine, Foothills Medical Centre, Calgary, Alberta, 2Department of Pathology, QEII Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, 3Department of Neuroradiology, Loma Linda University Medical Center, Loma Linda, California, and 4Division of Neurosurgery, Kelowna General Hospital, Kelowna, British Columbia, Canada
Published on line in November 2000


The patient was a 13 year old girl who suffered from back pain and recurrent falls for about one year. She had seen her physician for leg weakness one month before hospital admission. She was given crutches and eventually progressed to a walker one week prior to surgery. She was sent for an MRI study. On the day of presentation for the MRI, she was no longer ambulatory. The strength in her legs was markedly reduced with obvious spasticity. There was also a sensory level bilaterally at T8, and she had lost control of her bladder.

Axial CT showed destruction of the pedicle, transverse process, lamina, spinous process on the left as well as involvement of medial right lamina of the mid-thoracic vertebra (Fig 1). Axial proton density weighted MRI showed a large left posterior epidural soft tissue mass compressing and displacing spinal cord to the right (Fig 2). Sagittal T1 weighted MRI demonstrated a posterior epidural mass surrounded by normal epidural fat, compressing and displacing spinal cord anteriorly (Fig 3).

The girl underwent a T7 and T8 partial laminectomy and resection of the lesion. Intraoperatively, a firm fibrous red-grey mass was seen emerging from where the lesion had eroded the lamina of T7 and T8. The lesion extended into the left pedicles at T7 and T8. The surrounding bone appeared scalloped. An intraoperative frozen section was suggestive of a benign process and the lesion was subjected to gross total resection.



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