Case 3 -

Paraganglioma of the cauda equina Elisabeth Rushing Armed Forces Institute of Pathology Washington, DC

Virtual Slides as well as Still Images are displayed below.
For the fastest viewing of virtual slides, click:



under each thumbnail image below. You must have Aperio ImageScope installed on your PC.

If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:

Or, click on slide thumbnail images to view each slide
in a Web-based slide viewer, which is somewhat slower.

If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137.

Click here to download handout in 1-up pdf format for the current section Click here to download handout in 6-up pdf format for the current section Case History The patient is a 29 year-old male who experienced low-back pain of increasing severity that radiated down both legs. Subsequently, he was discovered to have a mass in the region of the cauda equina.   Magnetic resonance (MR) imaging showed an intradural mass localized to the conus medullaris and proximal cauda equina. The mass was isointense with spinal cord on all pulse sequences and enhanced avidly after administration of contrast material. Flow voids were seen on both T1 and T2-weighted images.   At surgery, the tumor appeared as a soft, sausage-shaped and well-encapsulated vascular mass. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Differential Diagnosis Myxopapillary ependymoma Schwannoma Meningioma (meningothelial) Final Diagnosis and References Paraganglioma of the cauda equina Key words: cauda equina, immunohistochemistry,myxopapillary ependymoma, paraganglioma, Take-home points Although rare, paragangliomas should always be considered in the differential diagnosis of cauda equina tumors. Features such as "zellballen" or packeted architecture, composed of uniform, polygonal chief cells with "salt and pepper" should raise suspicion. Paragangliomas may mimic the perivascular pseudorosette growth pattern of ependymomas. Immunohistochemical studies with neuroendocrine markers substantiate the diagnosis References Labrousse F, Leboutet MJ, Petit B, Paraf F, Boncoeur-Martel MP, Moreau JJ, Catanzano G. Cytokeratins expression in paragangliomas of the cauda equina. Clin Neuropathol . 1999; 18 :208-13. MoranCA, RushW, MenaH . Primary spinal paragangliomas. A clinicopathological and immunohistochemical study of 30 cases . Histopathology . 1997; 31 : 167-173 . Raftopoulos C, Flament-Durand J, Brucher JM, Stroobandt G, Chaskis C, Brotchi J. Paraganglioma of the cauda equina. Report of 2 cases and review of 59 cases from the literature. Clin Neurol Neurosurg. 1990;92:263-70. RochePH, Figarella-BrangerD, RegisJ, PeragutJC . Cauda equina paraganglioma with subsequent intracranial and intraspinal metastases . Acta Neurochir (Wien) . 1996; 138 : 475-479 . StrommerKN, BrandnerS, SariogluAC, SureU, YonekawaY . Symptomatic cerebellar metastasis and late local recurrence of a cauda equina paraganglioma. Case report. J Neurosurg . 1995; 83 : 166-169 . SonnelandPR, ScheithauerBW, LeChagoJ, CrawfordBG, OnofrioBM . Paraganglioma of the cauda equina region. Clinicopathologic study of 31 cases with special reference to immunocytology andultrastructure . Cancer 1986; 58 : 1720-1735 . Achilles E, Padberg BC, Holl K, Klöppel G, Schröder S. Immunocytochemistry of paragangliomas--value of staining for S-100 protein and glial fibrillary acid protein in diagnosis and prognosis. Histopathology.1991;18:453-8.