Tumors of the Spine

• Hemangioma – proliferation of blood vessels
• 75% are in vertebral body; 25% are multiple
• Most are asymptomatic (discovered in 10% of autopsies) but can present with pain or acute neurologic deficit (usually with hemorrhage), usually presents 30-50 years old
• CT shows polka dot pattern; MR shows presence of fat; enhances
• Osteoid Osteoma – painful benign nidus of osteoid material, vascularized osteogenic stroma, and poorly formed bone surrounded by reactive sclerotic bone
• Usually presents in long bones, but 10% are in spine (make up 6% of spinal tumors)
• M>F; 10-20 years old
• Usually in posterior elements (classic appearance – lumbar neural arch)
• X-ray/CT shows sclerosis around lytic lesion with calcified nidus of osteoid
• If greater than 2 cm, called osteoblastoma
• Osteochondroma – pedicle of normal bone protruding from the cortex covered with a rim of proliferating cartilage cells (from growth plate)
• Usually presents in long bones, but 5% are in spine
• M>F; 10-20 years old
• Outcropping of bony spicule at growth plate
• Usually on C2 spinous process or transverse process of other vertebrae
• Giant Cell Tumor of Bone – osteolytic tumor composed of multinucleated giant cells and ovoid or spindle-shaped cells
• Usually at ends of long bones, but can be found in sacral body
• Soft, reddish brown, lytic, expansile, benign but locally aggressive, 10% undergo malignant degeneration
• F>M, 10-40 years old
• Symptoms: pain, neuro deficit (if hemorrhage)
• Aneurysmal Bone Cyst – solitary benign expansile osteolytic lesion consisting of thin-walled blood-filled spaces (no elastic lamina) separated by fibrous tissue containing multinucleated giant cells
• Usually in metaphyses of long bones, but 20% are spinal, usually in cervical or thoracic posterior elements
• Nonneoplastic (enlarge by repeated hemorrhage?)
• Symptoms: pain, tenderness
• Eggshell cortical bone at periphery; cyst does not calcify
• Associated with chondroblastoma, giant cell tumor, osteoblastoma, and fibrous dysplasia
• Eosinophilic granuloma – painful solitary lesion consisting of numerous Langerhans cells, eosinophils, and occasional foci of necrosis
• M=F, 5-10 years old
• Lytic without sclerosis
• MRI: hyper on T2, enhances
• Chordoma – slowly growing solitary lytic soft tissue mass derived from persistent portions of the notochord; found in clivus or lumbosacral spine
• M>F, 50-60 years old
• Location:  Basicranial (clivus), sacrococcygeal; occurs in clivus or sacrum
• from remnants of notochord – Rare malignant degeneration of notochordal vestige originating in vertebral bodies or sacrum
• Most common in patients over 30 years of age
• cells arranged in lobules with abundant quantities of extracellular mucin
• some cells contain vacuoles of mucin that resemble soap bubbles (physaliphorous cells)
• cytokeratin+, EMA+, S100+
• chondroid chordoma – contains cartilage, better prognosis, cytokeratin-, EMA-, S100+
• Treatment:  Surgical excision and XRT (though tumor is not particularly radiosensitive, complete resection is rarely possible)
• Prognosis:  Slow tumor progressionlobulated with gray soft sheets of cells, large vacuolated cells (physalipherous) surrounded by mucin
• Lymphoma – neoplasm of lymph cells
• usually non-Hodgkin’s in spine
• M>F, 40-65 years old
• Ewing’s Sarcoma (endothelial myoma) – malignant neoplasm; usually metastasizes to spine from metaphyseal long bones
• M>F, 0-20 years old
• conspicuous foci of necrosis in association with irregular masses of small, regular, rounded, or ovoid cells (2 to 3 times the diameter of erythrocytes), with very scanty cytoplasm
• Osteosarcoma – most common and malignant of bone sarcomas
• arises from bone-forming cells
• M>F, 10-25 years old, usually have Paget’s disease
• Sunburst matrix calficication on CT
• Chondrosarcoma – malignant neoplasm derived from cartilage cells
• M>F, 50-70 years old
• Can arise from preexisting benign cartilaginous lesion (such as osteochondroma)
• Solitary Plasmacytoma of Bone
• Tumor composed of malignant plasma cells confined to a single bone site without evidence of systemic disease
• Peak incidence is in 5^th decade with 3:1 male to female predominance
• Location:
• 50% spine (thoracic > lumbar > cervical)
• 15% ilium/ischium/sacrum
• 3% skull
• Nearly all present with pain of  prolonged (>6 months) duration
• 25% develop neurologic compromise requiring surgical intervention
• Treatment: surgical if neurologic compromise or unstable spine; otherwise chemotherapy
• Prognosis:  70% ten-year survival, but most recur and eventually progress to multiple myeloma
• Multiple Myeloma
• Systemic disease of malignant plasma cells beginning in bone marrow and spreading outwards to soft tissue, organs, and blood
• Incidence is 3/100,000 population
• Peak incidence in 6^th decade with a slight male predominance
• Systemic symptoms include anemia, pancytopenia, hypercalcemia, proteinuria, impaired renal function, impaired hemostasis
• 10% develop neurologic compromise though nearly all cases involve the spine
• Treatment: surgical if neurologic compromise or unstable spine; otherwise chemotherapy
• Prognosis:  2.5 to 3 year mean survival
• Neuroblastoma
• Most common intra-abdominal and paravertebral malignancy in children
• Primitive tumor arising from neural crest stem cells
• Approximately 10% develop from the paravertebral ganglia as dumbbell shaped mass passing through vertebral foramen
• May metastasize to vertebral body
• Tumor has unique capacity to regress spontaneously or to differentiate into a benign ganglioneuroma
• Radiology:  skull films show enlargement of vertebral foramen, canal widening, posterior vertebral body scalloping, paraspinal soft tissue calcification
• MRI shows paravertebral mass extending into spinal canal
• Treatment:  Surgical excision