J Korean Neurosurg Soc.  2013 Feb;53(2):121-124. 10.3340/jkns.2013.53.2.121.

Granular Cell Tumor of the Intradural Extramedullary Spinal Cord : Report of Two Cases with Respect to Radiological Differential Diagnosis

• Lee CH
• Hyun SJ
• Lee JW
• Rhim SC

• KMID: 2190691
• DOI: http://doi.org/10.3340/jkns.2013.53.2.121

Abstract

Granular cell tumors (GrCTs) of the spinal cord are rare benign tumors with a high rate of local recurrence. Only 6 cases of spinal GrCTs have been reported. GrCT is difficult to distinguish from other benign tumors such as schwannoma using imaging. A radiological "speckled dots" sign may be a useful differentiating feature of GrCT based upon experience with two cases and a review of the literature.

Keyword

Granular cell tumor; Intradural extramedullary tumor; Spinal cord; Magnetic resonance imaging; Schwannoma

MeSH Terms

Diagnosis, Differential
Granular Cell Tumor
Magnetic Resonance Imaging
Neurilemmoma
Recurrence
Spinal Cord

Figure

• 

  Fig. 1 Preoperative magnetic resonance (MR) images. A : Midsagittal T2-weighted fat-suppressed MR images show an isosignal intensity mass at T1-2. The spinal cord is displaced to the right posterior side. At the center of the tumor, there are low signal speckled dots. B and C : Mid-sagittal T1-weighted MR image (B) and gadolinium-enhanced fat-suppressed MR images (C) reveal isosignal intensity and a homogenous well-enhanced tumor. Speckled dots are observed at the center of the tumor. There is no dura tail sign. D : Axial MR image shows a well-circumscribed tumor displaced to the left side. It shows no extension to the foramen. E : Coronal MR image reveals that the tumor is located eccentrically in the intradural extramedullary and compresses the spinal cord.

• 

  Fig. 2 Histologic examination. A and C : Cases 1 (A) and 2 (C) show granular cells with abundant eosinophilic granules in the cytoplasm. Hyalinizing fibrosis is also observed in all cases. Some lymphocytes have infiltrated the tumor. There is mild nuclear pleomorphism but no necrosis. B and D : The tumor cells are strongly and diffusely immunoreactive with S-100 protein in Case 1 (B) and Case 2 (D).

• 

  Fig. 3 Preoperative magnetic resonance (MR) images. A : A T2-weighted MR image shows an isosignal intensity mass at C5-6. B : A T2-sagittal MR image shows a tumor extending to the right foramen. Speckled dots in the center of the tumor are of low signal intensity in a T2-weighted MR image (arrow). C and D : T1-weighted MR images show an isointense and well-enhanced mass. E and F : Axial MR images show that the spinal cord is displaced to the left by the tumor. The tumor is mainly located in the extraforaminal area. Low signal speckled dots are observed in all sequences of MR images.

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