Case of Conus Paraganglioma: Case Report with Review

Abstract

Paragangliomas of spine are rare neuroendocrine tumors. They are World Health Organization grade 1 tumors with common location in cauda equina and filum terminale. We report a case of conus paraganglioma. A 57-year-old lady was admitted with low back pain with radiculopathy without bowel and bladder complaints. Magnetic resonance imaging (MRI) lumbosacral spine showed well-defined round-to-oval extramedullary lesion isointense on T1 and hyperintense on T2-weighted images at the level of L1 vertebra (suggestive of) neurogenic tumor. Intraoperatively reddish-brown capsulated tumor arising from conus with extension to filum and compressing the nerve roots was seen. Gross total excision of tumor was done. Microscopic examination showed well-encapsulated cellular tumor composed of sheets, anastomosing lobules, and nests of small, oval-to-round cells interspersed with blood vessels with mild nuclear atypia and occasional mitosis. Immunohistochemistry analysis was positive for synaptophysin and chromogranin suggestive of paraganglioma. Postoperative period was uneventful. MRI of dorso-lumbar spine showed no residual tumor. Patient was asymptomatic 5 months after surgery. The clinical, radiological, and pathological features of this rare tumor entity is presented.

Keywords

• paraganglioma
• spine