An Extra-Adrenal Paraganglioma in the Lumbar Spine: A Case Report

Spinal paragangliomas are rare, benign, slow-growing, highly vascular neuroendocrine tumours.We report a 51-year-old male with six months of progressive low back pain radiating to both lower limbs and no neurological deficit.Magnetic resonance imaging of the lumbosacral spine showed a well-circumscribed, ovoid intradural extramedullary lesion at the T12-L1 level measuring 8.1 × 9.2 × 35.0 mm that was hypointense on T1-weighted images, heterogeneously hyperintense on T2-weighted images, and enhanced avidly after gadolinium.The working diagnosis was schwannoma or ependymoma.The tumour, which arose from a single rootlet, was excised en bloc through a T12-L1 laminectomy.Histopathology showed nests of uniform cells in a Zellballen pattern within a rich capillary network with focal perivascular pseudorosettes, fewer than two mitoses per 10 high-power fields and no necrosis.The tumour cells were diffusely positive for synaptophysin and chromogranin and negative for glial fibrillary acidic protein and epithelial membrane antigen, with focal S-100 positivity confined to sustentacular cells and a Ki-67 index of 5%, establishing the diagnosis of a paraganglioma.The patient's pain resolved completely, and he remained free of deficit at six months.This case illustrates that ependymoma-like pseudorosettes do not exclude paragangliomas at this site, that immunohistochemistry is decisive, and that complete excision is curative without adjuvant therapy.