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NEUROIMAGE
Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 229-230

Extensive gliosis in the wall of cervico-dorsal syrinx masquerading intramedullary tumor


1 Department of Surgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India
2 Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India
3 Department of Pathology, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India
4 Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India

Date of Acceptance26-Jan-2009

Correspondence Address:
Amit Agrawal
Clinical and Administrative Head, Division of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.51312

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How to cite this article:
Agrawal A, Dulani R, Bhake A, Hiwale KM, Mahadevan A, Shankar S K. Extensive gliosis in the wall of cervico-dorsal syrinx masquerading intramedullary tumor. Neurol India 2009;57:229-30

How to cite this URL:
Agrawal A, Dulani R, Bhake A, Hiwale KM, Mahadevan A, Shankar S K. Extensive gliosis in the wall of cervico-dorsal syrinx masquerading intramedullary tumor. Neurol India [serial online] 2009 [cited 2019 Dec 7];57:229-30. Available from: http://www.neurologyindia.com/text.asp?2009/57/2/229/51312


A 32-year-old gentleman presented with weakness, tingling, and numbness of all the four limbs for one month. He was operated for hydatid liver four years back. There was grade 4/5 weakness of all the four limbs with spasticity in the lower limbs and decreased sensation below C4. Reflexes were exaggerated in lower limbs and sluggish in upper limbs. Magnetic resonance imaging (MRI) showed extensive cervico-dorsal syrinx [Figure 1],[Figure 2],[Figure 3]. Gadolinium-enhanced images showed heteroge­neously enhancing cystic lesion at C4-5 [Figure 4] and [Figure 5]. At surgery a gray-yellow, firm, well-defined mass was resected. The patient deteriorated by two grades immediate postoperatively, but recovered thereafter. Histopathological examination showed cystic lesion lined by ependymal lining. The wall showed dense fibrillary isomorphic gliosis entrapping anterior horn cells with numerous Rosenthal fibres [Figure 6]. No immature neuronal or glial elements were found. Characteristic biphasic pattern of a pilocytic astrocytoma with loose microcystic zones and eosinophillic granular bodies was not evident. The findings were suggestive of extensive gliosis in the wall of the syrinx [Figure 6].

In idiopathic syringomyelia, there are longitudinally oriented cavities with surrounding gliosis, attributed to arachnoiditis without any evidence of a true neoplasm.[1],[2] As in the present case clinically and radiologically these lesions can masquerade as intramedullary tumor with syringomyelia. [1],[2] The leading edge of the syrinx cavity dissects along longitudinal tissue planes leading to hypertrophic and hyperplastic gliotic changes. [1],[3] Gliosis is proportional not only to the age of the lesion but to the severity of the forces acting upon the walls, [4] and can be seen as circumferential bands producing "beaded" appearance. [3],[5] Gliosis is commonly associated with syringomyelia [1],[2],[5] and on MRI can show heterogeneous contrast enhancement. [2]

 
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1.Sherman JL, Barkovich AJ, Citrin CM. The MR appearance of syringomyelia: New observations. AJR Am J Roentgenol 1987;148:381-91.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Parizel PM, Balιriaux D, Rodesch G, Segebarth C, Lalmand B, Christophe C, et al. Gd-DTPA-enhanced MR imaging of spinal tumors. AJR Am J Roentgenol 1989;152:1087-96.  Back to cited text no. 2    
3.Escourolle A, Poiner J, editors. Manual of basic neuropathology. Philadelphia: Saunders; 1973. p. 19-34.  Back to cited text no. 3    
4.Williams B, Timperley WA. Three cases of communicating synngomyelia secondary to midbrain gliomas. J Neurol Neurosurg Psychiat 1976;40:80-8.  Back to cited text no. 4    
5.Greenfield JG. Synngomyelia and synngobulbia. In: Blackwood W, McMenemey WH, Mayer A, Norman RM, Russell DS, editors. Greenfield's neuropathology. Baltimore: Williams and Wilkins; 1963. p. 331-7.  Back to cited text no. 5    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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