Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report

Background: Juxtafacet cysts, synovial and ganglion cysts, emanate from the facet joints. Patients with these cysts are typically asymptomatic but may rarely present with radiculopathy and/or myelopathy. Case Description: A 72-year-old female presented with a 1-month history of progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. Notably, she also had a C7 sensory level to pin appreciation of 1-month duration. The magnetic resonance imaging showed an extradural C7 cystic lesion whose capsule enhanced with gadolinium, causing severe cord compression. The patient underwent a left C7 hemilaminectomy for complete excision of the cyst; postoperatively in 2-weeks duration, she regained full neurological function. The final histopathology was consistent with a ganglion cyst. Conclusion: Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.

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Subungual Ganglion Cyst Mimicking Glomus Tumor

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0001 ◽

2020 ◽

Vol 25 (2) ◽

pp. 128-133

Author(s):

Gyeong Hyeon Doh ◽

Bum Sik Kim ◽

HeaKyeong Shin ◽

Kyung Chan Ahn ◽

Ki Yong Hong ◽

...

Keyword(s):

Glomus Tumor ◽

Ganglion Cyst ◽

Complete Excision ◽

Nail Deformity ◽

Root Injury ◽

Ganglion Cysts ◽

History Of ◽

Mucous Cyst ◽

Clinical Triad ◽

The Right

Subungual masses accompanying nail deformity are of common occurrence and uniquely confirmed by histopathologic examination postoperatively. Although glomus tumor is most frequently diagnosed with its specific clinical triad, other rarer diagnoses have also been reported. Though ganglion cysts are predominantly found around the distal phalangeal joint as a mucous cyst and myxoid cyst, they might also appear as a subungual mass accompanied by nail deformity thereby mimicking the glomus tumor. A 54-year-old woman visited our outpatient clinic with nail deformity and pain on the tip of the right thumb. She had a history of nail root injury on her right thumb which occurred 3 months back at a nail shop. Physical examination revealed a convex point with tenderness on the right thumbnail. Doppler ultrasonography revealed the presence of 0.43×0.26×0.53 cm3 sized non-specific cystic lesion with hypoechogenicity and no abnormal vascularity. Complete excision of the cyst was performed and histopathology revealed a ganglion cyst. Subungual ganglion cyst is rarely occurred and known to be usually asymptomatic. Herein, we report a case of ganglion cyst of subungual area which was mistakenly diagnosed as a glomus tumor preoperatively.

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Extradural Thoracic Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome: Case Report

Neurosurgery ◽

10.1097/00006123-200211000-00025 ◽

2002 ◽

Vol 51 (5) ◽

pp. 1275-1279 ◽

Cited By ~ 26

Author(s):

Michael J. Alexander ◽

Peter M. Grossi ◽

Robert F. Spetzler ◽

Cameron G. McDougall

Keyword(s):

Spinal Cord ◽

Cord Compression ◽

Magnetic Resonance Imaging Scan ◽

Lower Extremity Weakness ◽

Thyrocervical Trunk ◽

Weber Syndrome ◽

History Of ◽

Cutaneous Hemangioma ◽

The Right ◽

Upper Thoracic

Abstract OBJECTIVE AND IMPORTANCE Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels. INTERVENTION The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.

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Giant schwannoma of the left maxillary sinus - a rare case report

Romanian Journal of Rhinology ◽

10.2478/rjr-2020-0014 ◽

2020 ◽

Vol 10 (38) ◽

pp. 63-65

Author(s):

Muhammad Adzha Musa ◽

Ahmad Nordin Affandi ◽

Prepageran Narayanan ◽

Tan Shi Nee

Keyword(s):

Maxillary Sinus ◽

Good Prognosis ◽

Deviated Nasal Septum ◽

Complete Excision ◽

Giant Schwannoma ◽

Rare Case Report ◽

History Of ◽

Left Maxillary Sinus ◽

The Right ◽

Inverted Papillomas

AbstractBACKGROUND. Polyps, cysts and mucocele are the commonest sinonasal tumors present unilaterally, as well as invasive tumors, such as inverted papillomas and squamous cell carcinomas. On the contrary, Schwannomas are rare lesions found in this area.MATERIAL AND METHODS. We present a case of a 48-year-old female who presented with a 2-year progressive history of left nasal obstruction, cranio-facial fullness sensation and pain, with intermittent epistaxis. The CT scan of the nose and paranasal sinuses showed complete opacification of the entire left nasal cavity and maxillary sinus, causing a deviated nasal septum to the right side.RESULTS. The tumor was completely excised endoscopically without any complication. Histopathology was consistent with that of a schwannoma.CONCLUSION. The diagnosis of sinonasal Schwannomas remains challenging, as it is a rare tumor and sometimes its clinical behaviour and imaging may be misleading. The treatment of choice for paranasal sinus schwannoma is complete excision of the tumor with good prognosis.

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Rare case of cystic hygroma in the epidural space resulting in multilevel spinal cord compression

BMJ Case Reports ◽

10.1136/bcr-2019-230326 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230326

Author(s):

Christopher Payne ◽

Michael J Gigliotti ◽

Alejandro Castellvi ◽

Alexander Yu

Keyword(s):

Epidural Space ◽

Lymphatic System ◽

Benign Lesion ◽

Cord Compression ◽

Cystic Hygroma ◽

Lymphatic Tissue ◽

Lower Extremity Weakness ◽

History Of ◽

Mass Lesions

Lymphangioma, or cystic hygroma, involving the epidural space and spinal soft tissue, is a rare benign lesion consisting of an abnormal collection of lymphatic tissue isolated from the normal lymphatic system. This case report is the most extensive case of cystic hygroma involving the spine reported in the literature. A 23-year-old man with a history of cystic hygromas of the neck and thorax presented with bilateral upper and lower extremity weakness that progressively worsened over 3 months. A left hemilaminectomy from C4 to T5 with endoscopic exploration and cyst drainage was performed. At last follow-up, the patient was ambulating and returned to work. Aggressive decompression of mass lesions resulting in myelopathy, such as the spinal cystic hygromas, resulted in improved motor function as well as overall function status.

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Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

Case Reports in Medicine ◽

10.1155/2010/705919 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Jake Sloane ◽

Vivek Gulati ◽

Sreeram Penna ◽

Philip Pastides ◽

Davinder Paul Singh Baghla

Keyword(s):

Anterior Cruciate Ligament ◽

Ganglion Cyst ◽

Cruciate Ligament ◽

Infrapatellar Fat Pad ◽

Knee Motion ◽

Ganglion Cysts ◽

History Of ◽

Manipulation Under Anaesthesia ◽

Magnetic Resonance Imaging Mri ◽

Anterior Cruciate

A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI) revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL), extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

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RARE-16. A PATIENT WITH MOSAIC POST-ZYGOTIC KRAS-G12D PATHOGENIC VARIANT PRESENTING WITH A SYMPTOMATIC SPINAL NEUROFIBROMA AND LARGE SEGMENTAL TRUNCAL CAFÉ AU LAIT SPOT

Neuro-Oncology ◽

10.1093/neuonc/noab090.177 ◽

2021 ◽

Vol 23 (Supplement_1) ◽

pp. i44-i44

Author(s):

Dardan Demaliaj ◽

Jianglin Ji ◽

Matthew Deardorff ◽

Peter Chiarelli ◽

Benita Tamrazi ◽

...

Keyword(s):

Mapk Pathway ◽

Mass Effect ◽

Neurofibromatosis Type ◽

Spinal Tumor ◽

Cord Compression ◽

Clinical Findings ◽

Pathogenic Variant ◽

Lower Extremity Weakness ◽

Resected Tumor ◽

History Of

Abstract An 11 year old boy presented with a three month history of progressive bilateral lower extremity weakness associated with recent intermittent incontinence. Spine MRI showed a right-sided T11-T12 paraspinal mass extending through the neural foramina into the epidural space and causing severe spinal cord compression. Skin showed a large macular lightly-hyperpigmented café au lait spot with irregular borders along the T10-T12 dermatome extending from the spine to approximately the anterior-axillary line. He was suspected to have segmental neurofibromatosis type 1 (NF1) as no additional clinical findings, radiographic features or family history of NF1 were identified. Patient underwent T10-12 laminectomy for resection of the epidural tumor component. Post-operative MRI showed resolution of the mass effect on the thecal sac and cord, with expected tumor residual lateral to the neural foramen. His residual spinal tumor and mild scoliosis remained stable over the two years of follow up to date. Pathological and molecular analysis of the resected tumor revealed a neurofibroma harboring an activating KRAS c.35G>A, p.Gly12Asp (KRAS-G12D) pathogenic variant at 27% variant allele frequency. Melanocytes cultured from two hyperpigmented skin biopsies showed the same KRAS-G12D pathogenic variant. This KRAS-G12D pathogenic variant was not found in leukocytes, indicating a post-zygotic origin. No NF1 pathogenic variant was identified in tumor tissue, melanocytes or leukocytes. The clinical findings were consistent with a mosaic KRASopathy due to a post zygotic KRAS-G12D pathogenic variant. The presence of the KRAS variant in the spinal neurofibroma and overlaying café au lait spot without an NF1 etiology in associated tissues demonstrates overlapping variability of presentations of RAS-MAPK pathway disorders. This case highlights the need for full clinical and genetic evaluation of patients presenting with segmental neurocutaneous disorders.

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SUN-486 Unusual Presentation of Metastatic Follicular Thyroid Cancer

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1561 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Nikoletta Proudan ◽

Kersthine Andre

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Follicular Carcinoma ◽

Cord Compression ◽

Whole Body ◽

Follicular Thyroid Cancer ◽

Lower Extremity Weakness ◽

History Of ◽

The Right ◽

Work Up

Abstract Distant metastasis of follicular thyroid cancer to the bone has been well documented. However, spinal cord compression as the initial presentation of metastatic follicular thyroid cancer without any thyroid symptoms is relatively rare. Here we discuss such a case. A 78-year-old female with history of HTN and melanoma presented to the ED with a 1-month history of middle back pain that progressed to lower extremity weakness, numbness, and inability to ambulate. MRI showed a T7 vertebral mass with cord compression and edema. Metastatic work up was unremarkable except for incidental bilateral thyroid nodules, the largest on the right lobe, at 1.6 cm, with peripheral calcifications. The patient underwent T6-T7 laminectomy with vertebral decompression, partial colpectomy, and T4-T10 fusion. Pathology of the thoracic vertebral mass was positive for CAM 5.2, cytokeran 7, TTF-1, and PAX8 consistent with either metastatic pulmonary adenocarcinoma or thyroid carcinoma. The patient denied shortness of breath, dysphagia, hoarseness, or neck tenderness. She had no personal history of hyperthyroidism or hypothyroidism, or radiation exposure. She also did not have any family history of thyroid cancer. Laboratory work up was significant for TSH of 3.71 mcU/mL (0.4-4.0 mcU/mL), Free T4 1.56 ng/dL (0.7-1.9 ng/dL), thyroglobulin (Tg) 6940 ng/mL (1.6-55.0 ng/mL), and thyroglobulin antibody (Tg Ab) 20 IU/mL (0-115 IU/mL). FNA of the right thyroid nodule showed follicular neoplasm with very similar morphological features to the epidural pathology, favoring a follicular carcinoma. She underwent total thyroidectomy. Pathology showed a 1.6 x 1.1 cm follicular carcinoma with capsular and angiolymphatic invasion, but with uninvolved margins of resection. TNM staging was pT1b, pNx, pM1. She was ablated with 109 mCi of I-131 after withdrawal therapy. Whole body scan after treatment revealed radioiodine avid metastatic disease at T7 and activity in the thyroid bed compatible with residual thyroid tissue. Patient completed 10 fractions of external beam radiotherapy to the spine for a total of 30 Gy. Three months follow up lab work showed Tg 580 ng/mL and negative Tg Ab with a suppressed TSH. Thyroid bed ultrasound did not show any residual tissue or abnormal lymph nodes. Ten-year survival rates in patients with bony metastatic differentiated thyroid cancer range from 13-21% (1). Metastatic thyroid carcinoma should be considered in the differential diagnosis of every patient with new onset bony metastasis and thyroglobulin should be considered as a tumor marker in the initial work up. Research shows increased survival with I-131 avidity and complete bone metastasis resection (1). 1. Ramadan, Sami et al. “Spinal metastasis in thyroid cancer.” Head & neck oncology vol. 4 39. 25 Jun. 2012, doi:10.1186/1758-3284-4-39

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Ganglion cyst arising from the composite occipito-atlanto-axial joint cavity in a cat

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-13-10-0119 ◽

2014 ◽

Vol 27 (04) ◽

pp. 319-323

Author(s):

S. Sadahiro ◽

M. Nishimura ◽

Y. Miyazaki ◽

M. Shibata ◽

T. Aikawa

Keyword(s):

Ganglion Cyst ◽

Clinical Signs ◽

Cord Compression ◽

Histological Evaluation ◽

Dorsal Spinal Cord ◽

Joint Cavity ◽

Initial Inability ◽

History Of ◽

Atlanto Axial Joint

SummaryA four-year-old, female spayed Domestic Longhaired cat was referred for evaluation with a two month history of initial inability to jump progressing to ambulatory tetraparesis. Magnetic resonance imaging studies demonstrated a cystic lesion arising from the composite occipito-atlanto-axial joint cavity and extending to the region of the occipital bone and the axis. The lesion surrounded the spinal canal, causing moderate dorsal spinal cord compression at the atlanto-occipital joint. A dynamic myelographic study demonstrated attenuation of the dorsal contrast column at the atlanto-occipital joint when the cervical spine was positioned in extension. Partial excision of the cyst capsule by a ventral approach resulted in long-term (64 months) resolution of clinical signs. Histological evaluation was consistent with a ganglion cyst. An intra-spinal ganglion cyst arising from the composite occipito-atlanto-axial joint cavity may be considered as an uncommon differential diagnosis for cats with cervical myelopathy.

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Segmental neurofibromatosis—induced spinal cord compression

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.2.0236 ◽

2001 ◽

Vol 95 (2) ◽

pp. 236-238

Author(s):

Natarajan Muthukumar

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Peripheral Nerves ◽

Cord Compression ◽

Lower Extremity Weakness ◽

Content Type ◽

Neuralgic Pain ◽

History Of ◽

Intercostal Neuralgia ◽

The Right

✓ Spinal segmental neurofibromatosis (NF) is a rare entity. To date, patients in reported cases of segmental NF (or NF5) have harbored neurofibromas involving the peripheral nerves only. The author reports a rare case of segmental NF that caused spinal cord compression in a 40-year-old woman who presented with a 6-month history of intercostal neuralgia. Examination revealed mild lower-extremity weakness and dysesthesia in the right-sided T-9 dermatome. Magnetic resonance imaging revealed three neurofibromas involving the T-9 region, which were excised, and the patient's neuralgic pain was resolved postoperatively. Traditionally, it has been believed that segmental NF involved only the peripheral nerves. The present case illustrates that although rare, spinal cord compression can also occur in patients with segmental NF.

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Spinal Angiolipoma

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052628 ◽

2001 ◽

Vol 28 (1) ◽

pp. 82-88 ◽

Cited By ~ 25

Author(s):

Daryl R. Fourney ◽

Karen A. Tong ◽

Robert J.B. Macaulay ◽

Robert W. Griebel

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Complete Excision ◽

Aggressive Approach ◽

History Of ◽

Epidural Fat ◽

Spinal Angiolipomas ◽

Spinal Epidural

ABSTRACT:Background:Spinal epidural angiolipoma is a rare cause of spinal cord compression. We present a case and review the clinical presentation, radiological appearance, pathological aspects and treatment of this distinct clinico-pathological entity.Methods:A case of a 46-year-old woman with a five-month history of progressive myelopathy affecting her lower extremities is presented. CT and MRI revealed a large epidural fat-containing mass compressing the spinal cord dorsally at the T7-T8 level. A laminectomy was performed with gross total resection of the lesion.Results:The patient's neurologic symptoms improved postoperatively. A two-year follow-up period has revealed no signs of tumor recurrence and no neurological deficit.Conclusion:The diagnosis of spinal angiolipoma should be considered in the differential diagnosis of spinal cord compression. Magnetic resonance imaging is the investigation of choice. The surgical objective is complete excision but, for anterior lesions involving bone, an overly aggressive approach should be tempered by an awareness of the overall indolent natural history of so-called "infiltrating" spinal angiolipomas that are only partially excised.

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