IgG4-related disease is an immune-mediated fibroinflammatory condition. Isolated manifestation in the spine as hypertrophic pachymeningitis is very rare and the mass-like lesion on MRI often mimic tumour or infection. Patients would present with symptoms that result from mass effect or neurovascular compression. Studies showed that serum and CSF IgG4 levels are rarely informative, and therefore, tissue biopsy is crucial for accurate diagnosis. Apart from supporting the diagnosis, MRI is helpful in delineating the extent of disease and follow-up after treatment. A 18F-FDG PET/CT scan is useful in detecting systemic manifestations of IgG4-related disease. Although IgG4-related disease generally responds well to corticosteroid at inflammatory state, relapse is not uncommon. Current treatment strategies for IgG4-related hypertrophic pachymeningitis are high dose corticosteroid therapy and early decompressive surgery to avoid chronic neurological complications. We described a case of a 27-year-old gentleman complaining of lower limb weakness and numbness. MRI showed a mass-like epidural lesion at the thoracic spine causing cord compression. Open biopsy of the epidural mass demonstrated histopathological characteristics of IgG4-related disease. Patient responded well to early surgical decompression of the spinal cord and corticosteroid as evidenced by symptom improvement and resolving mass on subsequent MRI study. However, a follow-up MRI revealed disease recurrence years later.

Desmoid tumors are locally aggressive, benign neoplasms originating in connective tissues. Although the exact pathophysiology remains unknown, antecedent trauma or surgery are believed to be important contributing factors. The occurrence of paraspinal desmoid tumor in pediatric patients is extremely uncommon. Here, we present an exceedingly rare case of a pediatric patient with no surgical or family history who developed a paraspinal desmoid tumor. A 9-year-old female patient presented with 4 months of progressive back pain, right lower extremity weakness, and numbness. Spinal imaging revealed a left epidural paraspinal mass compressing her thoracic spinal cord and extending into the left thoracic cavity. A multidisciplinary approach with neurosurgery and thoracic surgery enabled gross total resection of the lesion. The patient had complete resolution of her symptoms with no signs of residual tumor on postoperative imaging. Pathology revealed a desmoid tumor that avidly stained for beta-catenin. On her last follow-up, she developed a recurrence, to which she was started on sorafenib therapy. Desmoid tumors are rare connective tissue neoplasms that often occur after local tissue trauma, such as that caused by surgery. This report presents a rare case of a pediatric paraspinal desmoid tumor that occurred in a patient with no surgical or family history. Such tumors should undergo surgical resection for symptomatic relief and tissue diagnosis. Close clinical and radiographic surveillance are essential in these patients due to the high recurrence rates of desmoid tumor.

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Acute and chronic lower back pain can be commonly caused by intervertebral disc prolapse. This prolapse usually occurs in the dorsal direction and towards the anterior epidural space. In extremely rare cases, this migration/herniation can be seen approaching the posterior epidural space. One such rare instance has been recorded and described in our patient, a 53-year-old with a history of hypertension who presented with persistent lower back pain, radicular in nature, and recent acute aggravation, leading to mobility impairment. The patient experienced numbness in the lower limbs, urinary incontinence, and irregular bowel movements. Sensory deficits were noted along the L3 dermatome. The patient underwent an L3 laminectomy, revealing extruded disk fragments causing the compression. After surgery, the patient\'s power in the lower limbs began to improve, with significant recovery by discharge and complete resolution of bowel and bladder incontinence. This case highlights the diagnostic and therapeutic challenges of posterior epidural mass-like lesions in the lumbar spine, emphasizing the importance of prompt surgical intervention in restoring neurological function. The successful outcome underscores the significance of early diagnosis and intervention in such cases, ultimately improving the patient\'s quality of life.

Primary central nervous system lymphoma is a rare form of extranodal non-Hodgkin\'s lymphoma that occurs in the brain, spinal cord, leptomeninges, or eyes and typically remains confined to the central nervous system. Among them, malignant lymphoma presenting as a primary tumor of the spinal cord is extremely uncommon, and epidural mass formation is known to occur in only 0.8-2.8% of cases of malignant lymphomas. Furthermore, primary malignant lymphoma presenting as an isolated epidural mass is much rarer. Here, we report a case of primary malignant lymphoma of the thoracic spine presenting as an isolated epidural mass that did not involve the vertebral body or posterior element. Surgical decompression is essential to prevent further neurological deterioration. Here, we present a successful treatment strategy for this rare case.

Posteriorly migrated disc extrusion may mimic tumoral masses on MRI with contrast; still, this diagnosis must be evoked in patients presenting acute low back pain with a posterior epidural mass. We describe a case of epidural posterior migration of an inflammatory lumbar disc herniation in a young patient with acute lumbosciatica. MRI showed an intracanalar mass with intense global enhancement, which is an uncommon feature of this rare condition.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) typically found in the trunk, limbs, head, and neck represent 3-10% of all soft-tissue sarcomas. Although they typically originating from peripheral nerve Schwann cells, 2-3% arise from the spinal nerves and may be found within the spinal canal. Here, we present a 43-year-old male with an extradural thoracic MPNST contributing to marked cord compression and a progressive paraparesis.
METHODS: A 43-year-old male presented with a progressive paraparesis of 16 months\' duration. The MRI showed a posterior T2-T4 extradural tumor in the thoracic spine resulting in significant cord compression. Following a T2-T4 laminectomy and gross total excision of the epidural mass, the patient regained modest neurological function. Immunohistochemistry staining supported the diagnosis of thoracic spinal MPNST.
CONCLUSIONS: Rarely, spinal MPNST can be considered amongst the differential diagnoses of an extradural spinal tumor. In this case, gross total excision of a posterior T2-T4 epidural MPNST resulted in improvement in the patient\'s original paraparesis. Notably, immunohistochemistry staining helped confirm the diagnosis of a MPNST.

Spinal cord compression (SCC) is an uncommon, severe complication of Hodgkin lymphoma (HL), occurring in 0.2% of cases at the onset and in 6% during disease progression. We present a teenager with SCC with clinical onset of HL; her pre-existing neurological abnormalities covered the presence of an epidural mass, which could have misled us.
A 13-year-old girl presented with a three-month history of lower back pain and degrading ability to walk. She suffered from a chronic gait disorder due to her preterm birth. A magnetic resonance imaging of the spine revealed an epidural mass causing collapse of twelfth thoracic vertebra and thus compression and displacement of the spinal cord. Histological examination with immunohistochemical analysis of the epidural mass demonstrated a classic-type Hodgkin lymphoma. Early pathology-specific treatment allowed to avoid urgent surgery, achieve survival and restore of neurological function.
Children and adolescents with back pain and neurological abnormalities should be prioritized to avoid diagnostic delay resulting in potential loss of neurological function. SCC requires a prompt radiological assessment and an expert multidisciplinary management.

Vertebral aspergillosis is a rare infectious disease with a high mortality rate. We herein report a 70-year-old woman with acute myelogenous leukemia with myelodysplasia-related changes, nontuberculous mycobacteriosis, and bronchiectasis who presented with a fever and cough. Her clinical symptoms and laboratory test results suggested febrile neutropenia and pneumonia. However, her clinical course was further complicated by lower extremity weakness. Magnetic resonance imaging of the spine showed consolidation contiguously spreading toward the epidural space between the T4 and T5. Cytological testing of the pleural effusion revealed Aspergillus fumigatus. We also review and summarize previously reported cases of vertebral aspergillosis in Japan.

BACKGROUND: While it is a rare entity, spinal angiolipomas are well-defined benign tumors that have been described sporadically in the literature starting from the late 1800s. Composed of mature lipomatous and angiomatous elements, these tumors manifest neurological symptoms due to progressive spinal cord or root compression. We present a case of a thoracic spinal angiolipoma and review the relevant literature.
METHODS: A 68-year-old male with ongoing bilateral lower extremity weakness was found on enhanced magnetic resonance imaging to have an extradural mass in the thoracic spine causing cord compression. A T4-T8 laminectomy and complete excision of the epidural mass resulted in reversal of the patient\'s neurological symptoms. Histopathology identified the mass as a thoracic spinal angiolipoma.
CONCLUSIONS: Given its uncommon occurrence and excellent prognosis, our report serves as a reminder to always consider spinal angiolipoma in the differential diagnosis of epidural masses.