Answer for BIR CoW 07 Mar 2021
Cervical spinal dumbell neurofibroma
Findings
Large lobulated homogenous avidly enhancing intradural extramedullary soft tissue intensity lesion noted extending from inferior border of C2 vertebra to superior border of D2 vertebra . The lesion is causing causing compression and displacement of spinal cord to right lateral aspect with left neural foraminal extension (causing widening of neural foramen) and large left extraforaminal paravertebral extension (dumb bell shape). Spinal DTI images reveal displacement of the tracts to the right side with splaying.
Discussion
Spinal neurofibromas are the most prevalent group of spinal tumors. Occur sporadically or in association with Neurofibromatosis type-1 . A neurofibroma developing a “dumbbell tumor” is a situation which is quite often seen. Surgical intervention is indicated when myelopathy and motor deficits develop in the case of paraspinal neurofibromas. Of the paraspinal neurofibromas 72 %-intradural extramedullary localization, 14 % were extradural 13 % were dumbbell formation 1 % was with intramedullary localizations . Pedicle erosion and vertebral body scalloping are the most frequent findings on direct radiograph. Regular expansion of the interpedicular distance and intervertebral foramen may directly indicate the presence of the dumbbell tumor. Neurofibromas are hypodense in CT and causes bone remodelling Neurofibromas appear as iso- or hyperintense to the spinal cord on T1 -weighted images while they give hyperintense signal on T2 -weighted images. Dumbbell neurofibromas enhance avidly with gadolinium administration
References :
1.Dumbbell-Shaped Neurofibroma of the Upper Cervical Spine: A Case Report Feyzi Birol SARICA, Kadir TUFAN, Melih ÇEKİNMEZ, Bülent ERDOĞAN, Orhan ŞEN
2.Dumbbell-shaped neurofibroma of the upper thoracic spine: A case report S. Ashok Kumar, Manoj Kumar,1 and Monika Malgonde2doi: 10.4103/2278-330X.119925 3. Khong PL, Goh WH, Wong VC, Fung CW, Ooi GC. MR imaging of spinal tumors in children with neurofibromatosis 1. AJR Am J Roentgenol. 2003;180:413–7.
Findings
Large lobulated homogenous avidly enhancing intradural extramedullary soft tissue intensity lesion noted extending from inferior border of C2 vertebra to superior border of D2 vertebra . The lesion is causing causing compression and displacement of spinal cord to right lateral aspect with left neural foraminal extension (causing widening of neural foramen) and large left extraforaminal paravertebral extension (dumb bell shape). Spinal DTI images reveal displacement of the tracts to the right side with splaying.
Discussion
Spinal neurofibromas are the most prevalent group of spinal tumors. Occur sporadically or in association with Neurofibromatosis type-1 . A neurofibroma developing a “dumbbell tumor” is a situation which is quite often seen. Surgical intervention is indicated when myelopathy and motor deficits develop in the case of paraspinal neurofibromas. Of the paraspinal neurofibromas 72 %-intradural extramedullary localization, 14 % were extradural 13 % were dumbbell formation 1 % was with intramedullary localizations . Pedicle erosion and vertebral body scalloping are the most frequent findings on direct radiograph. Regular expansion of the interpedicular distance and intervertebral foramen may directly indicate the presence of the dumbbell tumor. Neurofibromas are hypodense in CT and causes bone remodelling Neurofibromas appear as iso- or hyperintense to the spinal cord on T1 -weighted images while they give hyperintense signal on T2 -weighted images. Dumbbell neurofibromas enhance avidly with gadolinium administration
References :
1.Dumbbell-Shaped Neurofibroma of the Upper Cervical Spine: A Case Report Feyzi Birol SARICA, Kadir TUFAN, Melih ÇEKİNMEZ, Bülent ERDOĞAN, Orhan ŞEN
2.Dumbbell-shaped neurofibroma of the upper thoracic spine: A case report S. Ashok Kumar, Manoj Kumar,1 and Monika Malgonde2doi: 10.4103/2278-330X.119925 3. Khong PL, Goh WH, Wong VC, Fung CW, Ooi GC. MR imaging of spinal tumors in children with neurofibromatosis 1. AJR Am J Roentgenol. 2003;180:413–7.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!