This study evaluates the effectiveness of CT and MR imaging in differentiating intradural extramedullary spinal schwannomas and meningiomas in a large group of patients. In addition, the study correlates tumour location, morphologic characteristics and enhancement pattern. From January 2000 to June 2007, we retrospectively reviewed 128 consecutive patients (51 male, 77 female; mean age at admission 53.8 years; range 17-83 years) with spinal intradural extramedullary tumours (92 schwannomas, 36 meningiomas) at our institution. Fifty-one of ninety-two schwannomas (55.4%) showed fluid signal intensity on T2-weighted MR images. Twenty-two of thirty-six meningiomas (61.1%) showed hyperintense signal intensity and thirteen of thirty-six meningiomas (36.1%) showed isointense signal on T2-weighted MR images. Fifty-four schwannomas (58.7%) showed rim enhancement and thirty-three meningiomas (91.7%) showed diffuse enhancement on contrast-enhanced T1-weighted MR imaging. Twenty-one meningiomas (58.3%) showed dural tail sign in contrast-enhanced T1-weighted MR imaging. Twenty-one meningiomas (58.3%) showed calcification on CT images. MR and CT imaging results are therefore useful for the differentiation of schwannomas from meningiomas of the spine.

Percutaneous CT-guided aspiration is an effective method for the management of lumbar intervertebral discal cysts.

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus.

To evaluate the clinicopathologic characteristics of early colorectal cancer (ECC), histopathologic and clinical features of 90 ECC patients who underwent surgical resection (not including the endoscopic polypectomized cases) and 1704 patients with advanced colorectal cancer were analyzed. Smaller size, better histologic differentiation, less lymph node (LN) metastasis, and better clinical outcome were observed in those with ECC than in patients with more advanced lesions. LN metastasis was found in 5 patients with ECC among the 56 patients who underwent bowel resection (8.9%). Tumors with LN metastasis were more frequently associated with deep submucosal invasion, absence of an adenomatous component within the tumor, sessile configuration, and lymphovascular invasion. Tumors showing deep submucosal layer invasion were associated with a more unfavorable histologic grade, lymphovascular invasion, LN metastasis, sessile morphology, and absence of an adenomatous component within the tumor. Recurrence was observed in two patients who underwent local excision for their submucosal cancer. One of the patients was salvaged after bowel resection, but one patient died of distant metastasis. From our data analysis and literature review, extensive submucosal invasion, lymphovascular invasion, sessile configuration, and tumors with no adenomatous component should be considered high risk factors for LN metastasis and recurrence after limited therapy.