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Rapid progression may indicate pathological under-diagnosis in a case of spinal cord astrocytoma

Hailin Zhu, Chao Li, Ji Yu, Harry huimin Chen


Introduction: Most intramedullary spinal cord tumors are low-grade gliomas and are usually characterized by slow progression.  This is a case of a patient histologically diagnosed as low grade intramedullary astrocytomas but with fast growing behavior.

Presentation of Case: A 67-year-old man who was diagnosed with a low-grade but-fast-growing intramedullary astrocytoma. He lost his ability to walk within 1 month after symptom onset.  Preoperative spinal MRI showed an intramedullary lesion from T2 to T4.  Decompression surgery was performed at the T2–T4 level and the tumor was partially removed, followed by standard radiotherapy and TMZ chemotherapy.  Histological examination showed a low-grade astrocytoma (WHO grade II).  However, the tumor rapidly progressed and the patient eventually developed disability in all four limbs.  MRI then showed the tumor to extend from C2 to T7.  The patient died of respiratory failure 17 months after his surgery.

Conclusions: This case indicated that for patient with low-grade spinal cord astrocytoma, if the clinical progression does not match the pathological diagnosis,the treatment plan should be reconsidered.


Intramedullary spinal cord tumors ( IMSCTs); low grade astrocytoma; sampling error; fast growing; tumor heterogeneity

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Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000, 93(2 Suppl):183-193

Benes V 3rd, Barsa P, Benes V Jr, Petr Suchomel. Prognostic factors in intramedullary astrocytomas: a literature review. Eur Spine J. 2009, 18(10): 1397-1422

Chamberlain MC. Temozolomide for recurrent low-grade spinal cord gliomas in adults.

Cancer. 2008, 113(5):1019-1024

Fakhreddine MH, Mahajan A, Penas-Prado M , Weinberg J, McCutcheon IE, Puduvalli V, Brown PD. Treatment, prognostic factors, and outcomes in spinal cord astrocytomas. Neuro Oncol. 2013,15(4):406-412

Nakamura M, Chiba K, Ishii K, Ogawa Y, Takaishi H, Matsumoto M, Toyama Y. Surgical outcomes of spinal cord astrocytomas. Spinal Cord. 2006,44:740-745

Ryu SJ, Kim JY, Kim KH, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE, Kim SH. A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation. Eur Spine J. 2016, 25(12):4067-4079

Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery. 2005,56(5):972-981

Santi M, Mena H, Wong K, Koeller K, Olsen C, Rushing EJ. Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer. 2003,98(3):554-561

Ito T, Sawakami K, Ishikawa S, Hirano T, Endo N, Kakita A, Takahashi H. Progression of paralysis is the most useful factor for differentiating malignant from benign intramedullary tumors. Spinal Cord. 2013, 51(4):319-321

Nakamura M, Tsuji O, Fujiyoshi K, Watanabe K, Tsuji T, Ishii K, Matsumoto M, Toyama Y, Chiba K. Cordotomy for patients with thoracic malignant astrocytoma. J Neurosurg Spine. 2010,13(4):418-423

Marchan EM, Sekula Jr RF, Jannetta PJ, Quigley MR. Long-term survival enhanced by cordectomy in a patient with a spinal glioblastoma multiforme and paraplegia. Case report.

Marchan EM, Sekula JRF, Jannetta PJ, Quigley MR. Long-term survival enhanced by cordectomy in a patient with a spinal glioblastoma multiforme and paraplegia. Journal of Neurosurgery: Spine. 2007,7(6):656-659

Viljoen S, Hitchon PW, Ahmed R, Kirby PA. Cordectomy for intramedullary spinal cord glioblastoma with a 12-year survival. Surg Neurol Int. 2014, 5:101

Shirato H, Kamada T, Hida K, Koyanagi I, Iwasaki Y, Miyasaka K, Abe H. The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys. 1995,33(2):323-328

Katoh N, Shirato H, Aoyama H, Onimaru R, Suzuki K, Hida K, Miyasaka K, Iwasaki Y. Hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumor. J Neurooncol. 2006,78(1):63-69


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