intramedullary tumor

WordNet

1. an abnormal new mass of tissue that serves no purpose (同)tumour, neoplasm

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/01 00:43:59」(JST)

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Spinal tumors
Classification and external resources
ICD-10	C72.0
ICD-9	192.2
DiseasesDB	31483
MedlinePlus	001403
eMedicine	orthoped/49 med/2993, radio/169
MeSH	C04.557.465.220

Spinal tumors are neoplasms located in the spinal cord. Extradural tumors are more common than intradural neoplasms.

Depending on their location, the spinal cord tumors can be:

• Extradural - outside the dura mater lining (most common)
• Intradural - part of the dura
  • Intramedullary - inside the spinal cord
  • Extramedullary- inside the dura, but outside the spinal cord

Pathology

Extradural tumors are mostly metastases from primary cancers elsewhere (commonly breast, prostate and lung cancer). Intradural tumours can be classified as intramedullary (within the spinal parenchyma) or extramedullary (within the dura, but outside the spinal parenchyma). Extramedullary tumours are more common than intramedullary tumours. Common extramedullary tumours include meningiomas, schwannomas, extramedullary ependymomas, haemangioblastomas, while intramedullary tumours include astrocytomas and intramedullary ependymomas.

Symptoms

Pain is the most common symptom at presentation. The symptoms seen are due to spinal nerve compression and weakening of the vertebral structure. Incontinence and decreased sensitivity in the saddle area (buttocks) are generally considered warning signs of spinal cord compression by the tumor. Other symptoms of spinal cord compression include lower extremity weakness, sensory loss, and rapid onset paralysis. The diagnosis of primary spinal cord tumors is very difficult, mainly due to its symptoms, which tend to be wrongly attributed to more common and benign degenerative spinal diseases.

Spinal cord compression is commonly found in patients with metastatic malignancy. Back pain is a primary symptom of spinal cord compression in patients with known malignancy. It may prompt a bone scan to confirm or exclude spinal metastasis. Rapid identification and intervention of malignant spinal tumors, often causing spinal cord compression, is key to maintaining quality of life in patients.

Diagnosis

The diagnosis of primary spinal cord tumors is difficult, mainly due to their symptoms, which in early stages mimic more common and benign degenerative spinal diseases. MRI and bone scanning are used for diagnostic purposes. This assesses not only the location of the tumor(s) but also their relationship with the spinal cord and the risk of cord compression.

Treatment

• Steroids (e.g. corticosteroids) may be administered if there is evidence of spinal cord compression. These do not affect the tumoral mass itself, but tend to reduce the inflammatory reaction around it, and thus decrease the overall volume of the mass impinging on the spinal cord.
• Radiotherapy may be administered to patients with malignant tumors. Radiation is usually delivered to the involved segment in the spinal cord as well as to the uninvolved segment above and below the involved segment.
• Surgery is sometimes possible. The goals of surgical treatment for spinal tumors can include histologic diagnosis, tumor local control or oncological cure, pain relief, spinal cord decompression and restoration of neurological function, restoration of spine stability, and deformity rectification. Extramedullary tumours are more amenable to resection than intramedullary tumours.
• The combination of Minimally Invasive Surgery and Radiation or Chemotherapy is a new, minimally invasive technique, pioneered at Mount Sinai Hospital, New York by Dr. Arthur Jenkins *[1] This treatment can be tailored to the particular tumor of the spine, either metastatic or primary. [2]

Some suggest that direct decompressive surgery combined with postoperative radiotherapy provide better outcomes than treatment with radiotherapy alone for patients with spinal cord compression due to metastatic cancer. It is also important to take into consideration the prognosis of the patients and their ambulation status at diagnosis, and treat accordingly.

References

UpToDate Contents

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• 1. 脊髄腫瘍​ spinal cord tumors
• 2. 転移性​の​胃腸膵管系神経内分泌腫瘍​：​腫瘍増殖​および​ホルモン​過剰分泌​による​症状​を​管理​するための​全身治療​の​選択肢​ metastatic gastroenteropancreatic neuroendocrine tumors systemic therapy options to control tumor growth and symptoms of hormone hypersecretion
• 3. 二次性中枢神経系​リンパ​腫​の​臨床症状​および​診断​ clinical presentation and diagnosis of secondary central nervous system lymphoma
• 4. 肺​の​大細胞神経内分泌癌​ large cell neuroendocrine carcinoma of the lung
• 5. 脊髄​に​影響​を​与​える​疾患​ disorders affecting the spinal cord

English Journal

• Intramedullary metastasis in breast cancer - A comprehensive literature review.

• Rostami R, Safarpour D, Tavassoli FA, Jabbari B.SourceDepartment of Neurology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Rezvan.rostami@yale.edu.
• Journal of the neurological sciences.J Neurol Sci.2013 Sep 15;332(1-2):16-20. doi: 10.1016/j.jns.2013.05.032. Epub 2013 Jun 15.
• BACKGROUND: Intramedullary breast cancer metastasis (IMBCM) is considered rare but its true incidence is unknown. Previous reviews of this subject are few and provided limited information.OBJECTIVE: To evaluate the precise location(s) of IMBCM, its concurrence rate with brain metastasis, its frequen
• PMID 23778028

• Differentiation between Intramedullary spinal ependymoma and astrocytoma: Comparative MRI analysis.

• Kim DH, Kim JH, Choi SH, Sohn CH, Yun TJ, Kim CH, Chang KH.SourceDepartment of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
• Clinical radiology.Clin Radiol.2013 Sep 10. pii: S0009-9260(13)00392-9. doi: 10.1016/j.crad.2013.07.017. [Epub ahead of print]
• AIM: To investigate magnetic resonance imaging (MRI) findings that could be used to differentiate intramedullary spinal ependymoma from astrocytoma, and to determine predictors for this differentiation.MATERIALS AND METHODS: MRI images of 43 consecutive patients with pathologically proven intramedul
• PMID 24034546

Japanese Journal

• 脊髄腫瘍・脊髄血管障害に対する手術治療:—術中蛍光診断/神経内視鏡を併用して—

• 遠藤 俊毅,中川 敦寛,冨永 悌二
• 脳神経外科ジャーナル 24(5), 310-317, 2015
•  本稿では脊髄髄内腫瘍, 脊髄動静脈奇形の手術を安全かつ確実に行うための手術中の工夫について紹介した. 脊髄髄内腫瘍の手術では, 5-ALAあるいはICGによる術中蛍光診断が有用である. これにより脊髄と髄内腫瘍の境界判別が可能になり, 腫瘍摘出率の増加と良好な予後につながった. 脊髄動静脈奇形の手術では, 三次元融合画像を用いて複雑な血管構造を可視化することが, 治療方針の決定に役立った. 手術 …
• NAID 130005072410

• 脊髄腫瘍の手術戦略:—手術根治性と機能回復の両立を目指して—

• 髙見 俊宏,内藤 堅太郎,山縣 徹,大畑 建治
• 脳神経外科ジャーナル 24(5), 301-309, 2015
•  脊髄腫瘍の手術では, 腫瘍の性状・局在等によって手術難易度が大きく異なる. 個々の病状を慎重に判断し, 最善の手術方針を決定しなければならない. 腫瘍制御と四肢・体幹機能温存の最良バランスが治療ゴールである. 手術手技, 神経モニタリング・術中画像による手術支援およびリハビリテーション・薬物治療などの術後療法の総合力が求められる. 本稿では, 手術方針で問題となるダンベル型神経鞘腫, 脊柱管腹側 …
• NAID 130005072409

• Surgical Management of Spinal Intramedullary Tumors: Radical and Safe Strategy for Benign Tumors

• , , ,
• Neurologia medico-chirurgica 55(4), 317-327, 2015
• … Surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. … We are sure that safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. …
• NAID 130005065366

Related Links

• Intramedullary Spinal Cord Tumors: Background, History of ...

Intramedullary spinal cord tumors, like the one depicted in the image below, refer to a subgroup of intradural spinal tumors that arise from cells within the spinal cord, as opposed to adjacent structures such as the nerve ...

• Spine Tumor

Spine Tumor A spinal tumor is an abnormal mass of tissue that has either grown within or metastasized to the spinal cord or bones of the spine. As a spinal tumor grows, it may compress nerve roots or the spinal cord itself All of ...

Related Pictures

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★リンクテーブル★

リンク元	「髄内腫瘍」
関連記事	「tumor」

「髄内腫瘍」

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英

intramedullary tumor

同

脊髄髄内腫瘍 intramedullary spinal cord tumor

同

intramedullary tumor

「tumor」

　　[★]

• n.

• 腫瘍、腫瘤、腫脹