Calcifying Pseudotumor of the Neuraxis: A Review of 17 Cases
Mark E Jentoft, Bernd W Scheithauer, Junji Shibahara, Joseph E Parisi. Mayo Clinic, Rochester, MN; Tokyo University Hospital, Tokyo, Japan
Background: Calcifying pseudoneoplasm of the neuraxis is a rare tumefactive calcific process that appears to be reactive in nature and involves the central nervous system, meninges, or paraspinal tissues and bone. It is morphologically distinct with amorphous variable calcified material that is often surrounded in part by a layer of mesenchymal-appearing cells. Often a chondrocalcific appearance is present and metaplastic bone may occur. Small studies and scattered case reports indicate that these lesions follow a relatively banal post surgical course with death reported rarely. The purpose of this study is to identify the location, behavior, and associations of this uncommon lesion.
Design: Files were reviewed for cases of calcifying pseudotumor of the neuraxis that underwent surgical excision at the Mayo Clinic Rochester over an 18 year period (1992 to 2010). A review of the subjects' pathology slides and the medical record was performed.
Results: A total of 17 cases 12 (female) & 5 (male) were identified, with an average age of 58.6 (28-82) years. 5 cases were intracranial, while 12 involved the spine/paraspinal tissues with a majority of these lesions (9) involving the lower lumbar spine &/or lumbosacral junction, 2 cases involved the thoracic spine, 1 involved the lower cervical spine. 4 of the lesions appeared to be related to a distinct cause, with 2 cases being related to prior injury specifically to the region, 1 case in the field of previous radiation therapy, and 1 associated with a dysembryoplastic neuroepithelial tumor (previously reported). Follow up was available on 13 subjects with an average follow up of 78.6 (3.4-195.3) months. No cases recurred; however 1 case at the foramen magnum had a residual lesion due subtotal resection because of proximity to a vertebral artery. This lesion has not increased in size or had worsening of symptoms with 22.1 months of follow up. 3 (of 13) died, but all were due to unrelated causes.
Conclusions: Calcifying pseudoneoplasms of the neuraxis is a rare lesion, cured by gross total removal, and may be associated with previous injury or an underlying neoplasm. Though these lesions appear to follow a relatively benign course, impingement or involvement of critical structures may prevent complete surgical removal.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 269, Tuesday Afternoon