MR imaging findings in primary spinal cord glioblastoma

Abstract

Spinal cord glioblastoma is a rare disease, with an aggressive course and a poor prognosis. We describe magnetic resonance imaging (MRI) findings, in 3 adult cases of biopsy-confirmed glioblastoma. Conventional MRI findings were unclear with regard to the differential diagnosis between this rare tumor and other more common spinal cord lesions, including less aggressive tumors such as ependymoma or pilocytic astrocytoma, abscesses or tumefactive demyelinating lesions. After reasonable exclusion of infectious/inflammatory conditions, a final diagnosis of glioblastoma was established based on histopathological analysis. The cases reported reflect the difficulty of early radiological diagnosis of spinal cord glioblastoma, and indicate the need to perform a biopsy once inflammatory-infectious conditions are excluded with appropriate laboratory tests.

Keywords: Glial tumors; MRI; Primary spinal cord tumors; Spinal cord glioblastoma.

Fig. 1

Spinal cord MRI from patient 1. Sagittal T1-weighted image shows an iso- to hypointense mass in the cervical cord (A). The lesion is better demarcated on the sagittal T2-weighted sequence (B). An intense peripheral enhancement is shown on the contrast enhanced axial and sagittal T1-weighted images (C-F). Observe the exophytic component of the lesion in its upper portion on the right side (arrows in E and F).

Fig. 2

Histological images from patient 1, showing a hypercellular proliferation composed of round-to-oval medium-sized nuclei, with foci of necrosis (A. hematoxylin and eosin stains, 200×), with strong and diffuse GFAP expression (B, 200×). Absence of IDH1 R132H mutation (C, 200×, with positive control in the inset), absence of ATRX expression with positive internal control, consistent with ATRX mutation (D, 200×), absence of p53 overexpression (E, 200×).

Fig. 3

Spinal cord MRI from patient 2. Sagittal T1-weighted image shows an iso- to hypointense mass in the conus medullaris (A). The lesion is better demarcated on the sagittal T2-weighted sequence (B). An intense peripheral enhancement delimiting a central area of necrosis associated with an eccentric enhancing nodule (arrow in C) is shown on the contrast-enhanced sagittal and axial T1-weighted images (C and D).

Fig. 4

Histological images from patient 2 (hematoxylin and eosin stains, 200×). The sample shows hypercellular proliferation composed of oval medium-sized nuclei, with mitotic activity and endothelial hyperplasia.

Fig. 5.

Spinal cord MRI from patient 3. Sagittal STIR image shows multifocal lesion that affects the cervical (C5-C7) and dorsal (D3-D5) spinal cord segments (A). Contrast-enhanced sagittal and axial T1-weighted images (B-E) demonstrates peripheral enhancement and a small necrotic center (arrows).

Fig. 6

Histological images from patient 3 (hematoxylin and eosin stains, 200×). Observe the hypercellular proliferation composed of large and medium-sized nuclei, multinucleated cells, and atypical mitoses, with endothelial hyperplasia.