Paraganglioma of the Cauda Equina: An Ultrastructural and Immunohistochemical Study of Two Cases

Abstract

The ultrastructural and immunohistochemical features of 2 paragangliomas arising in the cauda equina are described. In both cases the tumor cells were arranged in small nests or cords and contained characteristic neurosecretory granules, lamellar stacks of rough endoplasmic reticulum (RER), and some well-developed Golgi apparatuses in their cytoplasm. The cells varied in electron density; the darker cells, occasionally resembling sustentacular cells, were probably dehydrated light cells because they contained a few neurosecretory granules. Sustentacular cells were difficult to identify by electron microscopy, but irregularly distributed S-100 protein and glial fibrillary acidic protein (GFAP) were found in these cells by immunostaining. Many tumor cells contained abundant neurofilaments. Curiously, a few cytokeratin-positive cells were found in 1 case. On microscopic examination, a small area of ganglioneuroma was found associated with the paraganglioma in 1 case. Ganglionic differentiation was concluded to be frequent in paragangliomas of the cauda equina region as in duodenal paragangliomas.

Paragangliomas of the lumbar region

“…The interval between the initial symptoms and tumor diagnosis ranged from 1 day 24,80 to 20 years 15 (mean interval 150.80 Ϯ 12.65 weeks); in 56 cases the duration was not mentioned or not specific. 12,17,30,35,40,45,51,60,73,75,77,78,87 The duration of symptoms was longer in patients with uni-or bilateral sciatica (194.6 weeks), whereas the shortest duration of symptoms was observed in cases involving sudden motor deficit 24,77 and urinary retention. 18 Localization.…”

“…Size. Although data were provided for 122 cases regarding tumor size, in only 60 cases were the three dimensions detailed; 5,7,8,[11][12][13]16,20,23,24,27,32,35,[40][41][42]48,51,53,55,67,73,74,80,82,86,91,98,104 in 17 cases two dimensions were reported, 29,31,52,71,81,83,86,88,91,95 and in 45 only one dimension was detailed. 4,21,25,37,46,50,54,60,62,63,69,86,…”

“…Myelography. Myelography was performed in 69 cases 2,[4][5][6]11,12,[15][16][17]20,21,[27][28][29]35,37,40,41,53,55,62,63,69,[71][72][73][74][81][82][83]86,89,[93][94][95]104 and revealed evidence of some degree of obstruction.…”

“…9,11,15,33,58,72,75,85,87,89,92,94 Attachment to Anatomical Structures. In 57 cases (33.9%) the tumor was attached to a nerve root or the cauda equina, 3,4,[7][8][9][10][11][14][15][16]19,23,25,[27][28][29]31,[33][34][35][37][38][39][40]43,45,48,52,55,62,63,69,74,75,78,82,83,85,87,[89][90]…”

Giant Paraganglioma of the Cauda Equina in Adolescence: Magnetic Resonance Imaging Demonstration

“…In a review of 85 well-documented cases in the literature [ l, [4][5][6][7][8][9][10][11], the largest previously recorded tumor was 10 em long [ 1]. The lesion in the present patient is the largest on record, measuring 13 em long.…”