1 case of paraneurotic tumor in the horsetail region of the vertebral tube

Paraneurocyta is a neuroendocrine tumor derived from the neurofirst cells of the paraneurotic synosisThe paraneurocytoma (CEP) in The Mawei region is rare, with more than 254 cases reported in domestic and foreign literature since 1970The hospital admitted 1 case of CEP, reported as followsclinical dataman, 54, was admitted to hospital on 6 January 2018 for "three months of lower back pain"3 months ago, patients without obvious causes of lower back pain, visited the local hospital, lumbar vertebramr MRI examination, diagnosed as "lumbar vertebral spinal stenosis", small needle treatmentAfter treatment, the patient's symptoms did not see a clear relief, in order to seek a clear diagnosis, then came to the hospital, after examination and reading tablets (Figure 1a), to "the vertebral tube occupied lesions" admitted to the hospitalSpecialist examination: the patient was helped into the ward by the family, L2 level ratchet and vertebral muscle has obvious tenderness and pain, in addition to no other positive signsOn January 9, 2018, the intra-fusion fixation technique of the decompression plant bone was removed in the mid-into the vertebral tube after the full hemp downfallDuring the operation see about 4.6cm x 2.1cm x 1.5cm size rules of the rules class circular lumps, located under the epidural, horsetail nerve back side, gray red, boundary clear, texture, with local adhesion, tumor completely removed, surgical image as follows (Figure 1b-e)Pathological performance: gray red nodule syllin sample, size 3.5cm x 2.0cm x 1.0cm, cut light brown, gray, gray red, solid, local attached suspicious blood vessels, long 3cm, true diameter 0.3cm, take the wholeImmuno-grouped staining tests: CK (-), Vimentin (-), EMA (-), GFAP (-), CGA (-), SyN (plus), S-100 (supported cells, Ki-67, 2%), PR (-)Pathological diagnosis: paraneuroinoma in the vertebral tubePathology and postoperative X-rays can be seen in Figure 1discussparaneurotic tumor originated in the neuroblastal cluster of the nervous system sub-nervous section, which is a rare neuroendocrine system tumor Adrenal myelin is the main occurrence site of the tumor, only 6% occurs outside the adrenal glands, of which 90% occur in the neck artery and cervical vein ball, the central nervous system is rare Miller and Torack first described CEP in 1970, when they were considered a metastatic tumor with neuroendocrine function Lerman was first explicitly identified in 1972 It is reported that the annual incidence of tumors in Mawei area is about 0.07/100000, of which paraneurotinoma accounts for 3.5% to 4%, and about 4 to 8 cases are reported worldwide each year There are some difficulties in identifying metastatic tumors and neuropathic tumors that occur in the area, which may mislead the formulation of treatment regimens and postoperative expectations the most common clinical first symptoms in were low back pain, with a incidence rate of 43.1%, while sciatica and low back pain were 23.9%, and the incidence of sciatic nerve pain on one side was 8.1% About 6.8 percent of patients with motor impairment, about 2.5 percent with sensory dysfunction and about 2.9 percent with sphincter and erectile dysfunction Clinical intracranial hypertension accounted for 2.9% of symptoms Usually, diagnosis is more than 1 year after the onset of symptoms (ranging from 1 to 7 years), which reflects the nonspecificness of clinical symptoms of neurocytoma in horsetail Systemic manifestations caused by catecholamines are rare in CEP, as paraneurorhoids in the horsetail region are considered unable to secrete or release hormones into the blood, thus showing no systemic performance CT sweep is difficult to detect tumors, which can easily lead to missed or misdiagnosis The preferred examination of paraneurocyta in the vertebral tube is MRI, generally in T1WI is a low to equidistant signal, T2WI is a medium to high signal, sometimes the T2WI signal can be uneven, converting blood vessels and deposited on the edge of the tumor iron hemoglobin helps to identify paraneurosaroma The curly blood vessels are located in the vertebral tube above the tumor, the curvature of the blood vessels flow air shadow can be seen around the tumor, the curvature blood vessels in the enhanced scan show the abnormal reinforcement The gold standard for the diagnosis of paraneurocyl in the vertebral tube is a pathological examination View of the naked eye: 0.5 to 13cm diameter, most of the paraneurotic membrane complete, only a few malignant appearance of the envelope membrane incomplete; Microscope: The main cell and the supporting cells form a paraneurotic tumor The main cell is multi-shaped, round, cytoplasmic rich, the nucleus is round, round, the nucleus is not obvious and the nucleorate is rare, part of the nuclear shape is larger, the cells are chip nest-like, island-like or "organ-like" arrangement, interstitial memory in the rich blood and sinus cell fiber tissue separation, support ingenuity around the main cell Immune grouping: Syn, CgA, NSE and support cell S-100 are positive, and EMA and GFAP are not usually expressed Electroscope examination: paraneurotic tumors are divided into "light cells" and "dark cells", the surface has a little cilia and microfluorcies, between which are connected by bridge grains, the cytoplasm is visible mitochondria and other organelles Neuroendocrine particles with a diameter of 80 to 200 nm in the cytoplasm are the most characteristic most paraneurotic syllatommembranes are intact, so the preferred treatment is tumor full-cutting Most scholars believe that it belongs to THE WHOI level, if the operation can be completely removed, the general recurrence rate is low, the prognosis is good, is not recommended for conventional radiotherapy after surgery However, there have also been reports of distant metastasis or recurrence of paraneurotic tumors Some scholars have pointed out that the paraneurotic tumor in the thoracic vertebral tube is better at the epidural and is more prone to distant metastasis Whether or not tumor metastasis is the main criterion for judging its good and malignant In view of the tendency of recurrence and distant metastasis of paraneurocydoma in the vertebral tube, it should be followed up for a long time after surgery For patients with relapses, surgery can be considered if they can have surgery again For patients with tumor residues or multiple cerebrospinal fluid metastasis, radiotherapy can be selected Chemotherapy is of little significance to paraneurotic tumors in summary, the intradural sub-neurometma is a rare benign tumor, although neuroendocrine tumor, but rarely appear systemic symptoms, many because of its occupatic symptoms are found The prognosis is better, but there is the possibility of metastasis and recurrence, the treatment is preferred surgical excision, after surgery generally do not require radiotherapy, but long-term follow-up