Abstract
Background: Cauda equina and filum terminale neuroendocrine tumours are rare neoplasms that develop in the cauda equina or filum terminale region of the spinal cord. Paragangliomas are grade 1 tumours (WHO grade I) that originate from neural crest cells. The diagnosis of paragangliomas is primarily based on histopathological findings, as there are usually no specific clinical or radiological indications. On radiological examination, they present as tumours similar to schwannomas and ependymomas.
Observation(s): A 59-year-old male patient presented at the neurosurgery clinic with a history of chronic low back pain. The patient underwent contrast-enhanced magnetic resonance imaging of the lumbar vertebrae. On the basis of the MRI imaging, a differential diagnosis of a typical filum terminale ependymoma or neuroma was considered. The patient underwent a decompressive laminectomy, a surgical procedure performed to relieve pressure on the spinal cord. The mass was excised en bloc and submitted for pathological examination. A total of 13 distinct immunohistochemical examinations were conducted for the purpose of differential diagnosis.
Discussion: The histopathological diagnosis of paragangliomas is challenging, with the primary differential diagnosis being ependymoma and metastatic paragangliomas to this region. A meticulous approach is essential when dealing with tumours exhibiting such morphology, as this allows for the exclusion of other tumours with analogous histopathological findings and the performance of a comprehensive panel to ascertain the nosological origin.
Conclusion: Surgical intervention represents the primary treatment option, and there is currently no definitive consensus on the use of chemoradiotherapy.
