Primary Isolated Amyloidoma of the Lumbar Spine Causing Neurological Compromise: Case Report and Literature Review

Haridas, Avinash; Basu, Sunandan; King, Andrew P.; Pollock, Jonathan

doi:10.1227/01.neu.0000163423.45514.bc

Cited by 34 publications

(21 citation statements)

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“…Reports of spine amyloidomas are rare: 20 cervical, 20 thoracic, five lumbar, one cervicothoracic, and one thoracolumbar have been published. Cases of cervical amyloidoma are presented in Table .…”

Section: Discussionmentioning

confidence: 99%

Primary cervical spine AL‐κ amyloidoma: A case report and review of the literature

et al. 2019

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Of the myriad of variants of amyloidoses where abnormally folded proteins damage native tissue, primary cervical spine amyloidoma represents one of the rarest forms. Since clinical presentations and imaging findings appear similar to other pathologies, including abscesses, metastatic lesions, and inflammatory lesions, a definitive diagnosis requires a biopsy with specific immunohistochemical stains. We present the first known case of primary cervical amyloid light‐chain (AL)‐κ subtype amyloidoma and compare the clinical presentations, imaging findings, treatment options, and immunohistochemical subtypes of primary, hemodialysis, and multiple myeloma cervical amyloidomas. Our case is of a 58‐year‐old man who developed neck pain radiating to the left arm with bilateral upper extremity weakness over several months. Magnetic resonance imaging revealed a circumferential C1–C2 mass extending into the neural foramina inducing severe mass effect. The patient underwent C2 laminectomy and resection of the lesion which was discovered during surgery to be completely epidural. Postoperatively, his pain and weakness improved. A complete work‐up was negative for systemic amyloidosis or inflammatory conditions. In the setting of a long clinical history of hemodialysis, this patient required specific staining and laboratory testing to correctly diagnose his primary cervical AL‐κ subtype amyloidoma. Cervical amyloidomas comprise a very small minority of amyloid pathology with an exceptional prognosis following successful surgical resection and stabilization. It is recommended these patients undergo surgical resection with appropriate characterization and a complete work‐up to rule out systemic disease.

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Section: Discussionmentioning

confidence: 99%

Primary cervical spine AL‐κ amyloidoma: A case report and review of the literature

et al. 2019

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“…A variety of proteins may be deposited in nerves with systemic amyloidosis, resulting in severe progressive mixed neuropathy and autonomic dysfunction. 17,32 The MR imaging appearance of amyloidosis of nerves has also been described (Fig 16). 33 …”

Section: Neoplasia and Tumor Variantsmentioning

confidence: 96%

High-Resolution MR Neurography of Diffuse Peripheral Nerve Lesions

Thawait¹,

Chaudhry²,

Thawait³

et al. 2010

AJNR Am J Neuroradiol

172

103

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SUMMARY:High-resolution MR imaging of peripheral nerves is becoming more common and practical with the increasing availability of 3T magnets. There are multiple reports of MR imaging of peripheral nerves in compression and entrapment neuropathies. However, there is a relative paucity of literature on MRN appearance of diffuse peripheral nerve lesions. We attempted to highlight the salient imaging features of myriad diffuse peripheral nerve disorders and imaging techniques for MRN. Using clinical and pathologically proved relevant examples, we present the MRN appearance of various types of diffuse peripheral nerve lesions, such as traumatic, inflammatory, infectious, hereditary, radiationinduced, neoplastic, and tumor variants.ABBREVIATIONS: CIDP ϭ chronic inflammatory demyelinating polyneuropathy; CMT ϭ CharcotMarie-Tooth; fat sat ϭ fat saturated; FLAIR ϭ fluid-attenuated inversion recovery; FLH ϭ fibrolipomatous hamartoma; GBS ϭ Guillain Barré syndrome; CMT/HSMN ϭ Charcot-Marie-Tooth/hereditary motor and sensory neuropathy; MMN ϭ multifocal motor neuropathy; MPNST ϭ malignant peripheral nerve sheath tumor; MRN ϭ MR neurography; NF1 ϭ neurofibromatosis type 1; NL ϭ neurolymphomatosis; SE ϭ spin-echo; SNR ϭ signal-to-noise ratio; SPACE ϭ sampling perfection with application-optimized contrasts by using different flip angle evolutions; SPAIR ϭ spectralattenuated inversion recovery; STIR ϭ short-tau inversion recovery; T1WI ϭ T1-weighted imaging; T1WIFS ϭ T1-weighted fat-saturated imaging; T2WI ϭ T2-weighted imaging; T2WIFS ϭ T2-weighted fat-saturated imaging H igh-resolution MR imaging of peripheral nerves is becoming more common and practical with increasing availability of 3T magnets. These magnets provide high SNR, which can be used for a quicker acquisition time as well as higher image contrast and resolution. There have been multiple reports of MR imaging of peripheral nerves in compression and entrapment neuropathies.1-3 However, there is a relative paucity of literature on the MRN appearance of diffuse peripheral nerve lesions. 4 These lesions seen on MR imaging present a diagnostic dilemma because a long list of pathologies could be causing them. We attempt to highlight the salient imaging features of myriad diffuse peripheral nerve disorders and to describe a diagnostic approach to these lesions on the basis of the available literature and our experience in this area. Various clinical and pathologically proved relevant examples of these pathologies are illustrated. . T1WI demonstrates fat planes delineating the normal nerve (perineural fat). C, Axial STIR SPACE at the level of the thighs shows an abnormal sciatic nerve. Notice the enlarged size and T2 hyperintensity of the fascicles. The dark rim of perineural fat is also disrupted. Also note posterior compartment denervation muscle edema (arrows).

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“…Of these, 16 were cervical [5,10,11,[15][16][17][18]24,[27][28][29]31,33,35,37,41], 19 were thoracic [1,3,4,[7][8][9][19][20][21][22][23]26,30,32,34,36,[38][39][40], three were lumbar [2,13,25] and one was thoracolumbar [6]. Notably, all reported patients describe extradural amyloidomas making our patient, to our knowledge, the first with an intradural, extramedullary amyloidoma.…”

Section: Discussionmentioning

confidence: 99%