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Review
. 2019 May;7(10):222.
doi: 10.21037/atm.2019.04.46.

Molecular foundations of primary spinal tumors-implications for surgical management

Tej D Azad  1 , Bowen Jiang  2 , Chetan Bettegowda  2
Affiliations
Review

Molecular foundations of primary spinal tumors-implications for surgical management

Tej D Azad et al. Ann Transl Med. 2019 May.

Abstract

Primary spinal tumors are rare lesions that require careful clinical management due to their intimate relationship with critical neurovascular structures and the significant associated risk of morbidity. While the advent of molecular and genomic profiling is beginning to impact the management of the cranial counterparts, translation for spinal tumors has lagged behind. Maximal safe surgical resection remains the mainstay of patients with primary spinal tumors, with extent of resection and histology the only consistently identified independent predictors of survival. Adjuvant therapy has had limited impact. To develop targeted neoadjuvant and adjuvant therapies, improve prognostication, and enhance patient selection in spinal oncology, a thorough understanding of the current molecular and genomic landscape of spinal tumors is required. In this review, we detail the epidemiology, current standard-of-care, and molecular features of the most commonly encountered intramedullary spinal cord tumors (IMSCT), intradural extramedullary (IDEM) tumors, and primary spinal column malignancies (PSCM). We further discuss current efforts and future opportunities for integrating molecular advances in spinal oncology with clinical management.

Keywords: Intramedullary spinal cord tumor (IMSCT); chordoma; genomics; meningioma; schwannoma.

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Conflict of interest statement

Conflicts of Interest: C Bettegowda is a consultant for Depuy-Synthes. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Spinal cord ependymoma. Preoperative sagittal T1-weighted, fat-saturated pre-gadolinium (A) and post-gadolinium (B) MRI demonstrates a discrete, enhancing C2 intramedullary mass. Sagittal T2-weighted MRI (C) reveals characteristic T2 hyperintensity. Associated hemorrhage may lead to a hypointense hemosiderin rim on T2 images.
Figure 2
Figure 2
Spinal myxopapillary ependymoma. Preoperative sagittal T2-weighted (A) and T1-weighted, fat-saturated, post-gadolinium (B) MRI reveals 5.9 cm mixed cystic and solid intradural lesion with enhancing mural nodule arising from the conus medullaris at the T12-L2 levels. Associated pathologic T2 hyperintensity within the conus medullaris is observed superior to the lesion.
Figure 3
Figure 3
Spinal cord astrocytoma. Preoperative sagittal (A) MRI demonstrates T2 hyperintensity within the cord at T11, measuring 1.3 cm × 0.6 cm in craniocaudal and AP dimensions. Axial (B) image reveals the lesion expanding the cord, measuring 9 mm in transverse dimension.
Figure 4
Figure 4
Spinal meningioma. T1-weighted MRI of the cervical spine reveals an extra-axial intraspinal soft tissue mass lesion with dural tail occupying the spinal canal at the C5–C6 level. The mass homogeneously enhances and exerts mass effect on the cord.
Figure 5
Figure 5
Spinal schwannoma. Preoperative axial (A) and sagittal (B) post-gadolinium MRI demonstrates a heterogeneously enhancing mass centered in the left C2–C3 neural foramen with intraspinal canal extension resulting in marked compression of cord.
Figure 6
Figure 6
Spinal chordoma. Preoperative T2-weighted (A) and T1-weighted, fat-saturated, post-gadolinium (B) MRI reveals a large pre-vertebral mass extending from C2–C5, characterized by abnormal signal and enhancement in the C3 vertebral body.
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