Paragangliomas of the cauda equina are rare neuroendocrine tumors. We present a case of nonsecreting paraganglioma of the cauda equina, preoperatively misdiagnosed as neurofiroma. A 42year old lady presented with pain and burning sensation in the lower back. MRI showed an intradural / extra medullary well defined mass at the L4,L5 level. Microscopic examination of the resected tumor revealed paraganglioma. The tumor cells were positive for chromagranin and synaptophysin. Although it is difficult to correctly diagnose paraganglioma preoperatively , especially in the region of cauda equina, it should be included in differential diagnoses. Introduction A paraganglioma of cauda equina region is extremely rare and since most of them are nonsecreting tumours, the pre-operative diagnosis of paraganglioma is very difficult. Histologically these neoplasms may have considerable similarity with ependymoma, the most common neoplasm of the lower spinal cord, and the diagnosis can be easily missed unless special techniques are employed. The clinical and pathological data obtained from this and the other reported examples suggests that paragangliomas of the cauda equina are benign, slowly growing neoplasms. In contrast to ependymomas and to paragangliomas elsewhere, they are well circumscribed, amenable to complete resection and have an excellent prognosis. Case Report A 42year old female presented with pain and burning sensation in the lower back . Pain was moderate and intermittent initially and became continuous in the last six months. Pain was radiating to the gluteal region and increased on coughing and taking deep breath. There was no history of urinary or bowel problem. On clinical examination ,motor and sensory systems were within normal limits. All the reflexes were present. The spine showed no deformity. X ray of the lumbar spine was also normal However MRI showed an intradural / extra medullary well defined mass at the L4,L5 level. Possibilities of neurofibroma and ependymoma were suggested. Laminectomy of L3- S1 with near total excision of the tumor was conducted and 3x3 c.m multilobular pinkish, friable mass arising from cauda equine was excised.Pathological Findings We received three pale tan coloured soft tissue masses measuring 2.5 x 1x0.5c.m.with nodular outer surface. Cut surface of these were pale tan in colour with areas of hemorrhage. On Microscopic examination, The tumor was partially encapsulated and comprised of nests and broad anastamosing trabaculae of round to polygonal cells tumor cells separated by delicate fibrovascular septa ( zellballen pattern).These tumor cells showed moderately abundant eosinophilic cytoplasm , central round to oval nucleus with finely stippled chromatin, occasional nucleolus and intranuclear inclusion. The tumor cells were positive for chromogranin and synaptophysin.
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