Multiple intraspinal tumor

Except in cases of neurofibromatosis, it is very rare for tumors of different pathological types to exist concurrently at the same spinal level, with only 9 cases reported to date, in which spinal meningioma was found with spinal schwannoma in 7 cases and with spinal neurofibroma in 2 cases.

Zhan et al., reported another rare case in which neurofibroma and meningioma were identified within a single dumbbell tumor at the same cervical level without neurofibromatosis. Preoperative magnetic resonance imaging indicated a single extra- and intradural extramedullary dumbbell-shaped neurogenic tumor on the left ventral side of the cervical spine. Intraoperatively, they found that the mass consisted of two pathologically different tumors. The results of surgical resection were mostly satisfactory.

The present case is the first reported case of intradural neurofibroma (not meningioma) and extradural meningioma growing mixed together at the same spinal level without neurofibromatosis. The precise mechanism underlying the formation of the tumor is unknown, and multidirectional differentiation of a common progenitor cell is one possibility. Intra- and extradural exploration and component biopsies are useful for treatment planning, especially when magnetic resonance imaging is not sufficiently sensitive for diagnosing coexisting tumor types ¹⁾.