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Images in Neurology |

Intradural, Extramedullary Anaplastic Astrocytoma Arising From the First Sacral Nerve Root

Nils Tiebel, MD1,2; Adam Lichota, MD1; Wolfram Scharbrodt, MD1; Ann-Freya Foerster, MD3; Christian Toedt, MD3; Guido Reifenberger, MD, PhD4; Bastian Malzkorn, MD4
[+] Author Affiliations
1Department of Neurosurgery, Community Hospital Herdecke, Herdecke, Germany
2now with the Department of Neurosurgery, Klinikum Solingen, Solingen, Germany
3Department of Neuroradiology, Community Hospital Herdecke, Herdecke, Germany
4Department of Neuropathology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
JAMA Neurol. 2013;70(11):1450-1451. doi:10.1001/2013.jamaneurol.368.
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A 48-year-old woman presented with a 6-month history of lumbosacral pain with sciatic distribution and paresthesia in the left S1 dermatome. She showed no motor weakness or bladder or rectal dysfunction. The preoperative magnetic resonance image (MRI) of the lumbar spine showed an intradural, extramedullary cystic mass extending along the left S1 nerve root through the intervertebral foramen (Figure 1). The patient underwent microscope-assisted neurosurgical tumor resection via a lumbar posterior approach. Intraoperatively, the tumor was regarded as a peripheral nerve sheath tumor.

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Figure 1.
Radiological Features: T2-Weighted Magnetic Resonance Image of the Lumbar Spine

Sagittal slice showing an intradural, extramedullary cystic mass lesion dorsal to the fifth lumbar and first sacral vertebral body that extends along the left S1 nerve root (arrows).

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Figure 2.
Histochemical and Immunohistochemical Features

A, Hematoxylin-eosin staining showing peripheral nerve tissue with diffuse cellular infiltrates of an astrocytic tumor. B, Immunohistochemical staining for mutant isocitrate dehydrogenase 1 (R132H), which is detectable in a high percentage of diffuse and anaplastic astrocytomas, supports the diagnosis of an astrocytic glioma. C, Immunostaining for neurofilament proteins demonstrating residual axons within the tumor tissue (original magnification ×400).

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