title: Paraganglioma of the cauda equina region.
abstract: BACKGROUND
  Cauda equina paragangliomas (CEPs) are rare neuroendocrine tumors. The difficulty in differential diagnosis with other tumors of this region may be misleading for surgical planning and prognostic expectations.
  
  
  OBJECTIVE
  To report on a rare case of CEP and review the most current information regarding the diagnosis, treatment options, and outcomes.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  One patient affected by CEP.
  
  
  METHODS
  We report on a 33-year-old woman with a 2-month history of worsening low back pain, aggravated by sitting, bending, and coughing. Neurological examination revealed normal power and muscular tone, no sensory or sphincter abnormality, and normal reflex. Magnetic resonance imaging of the lumbar spine demonstrated an intradural extramedullary lesion at L3, with homogeneous contrast enhancement and hypointense punctate foci. The patient underwent an L3 laminectomy and tumor removal. Relevant articles covering CEPs from 1970 to the present were reviewed.
  
  
  RESULTS
  The histopathological examinations described paraganglioma features. The postoperative course was uneventful, and all the symptoms resolved, with no tumor recurrence after 3 years' follow-up.
  
  
  CONCLUSIONS
  Cauda equina paragangliomas are rare, benign, and slow-growing tumors. Except for its secreting tumor characteristics, preoperative CEP diagnosis is very difficult. Magnetic resonance imaging is important and may suggest specific radiological features for these tumors; however, these are only relative, and it is rare that diagnosis is made before surgery. Diagnosis is established by histological examination and electron microscopy, and immunohistochemical techniques must be used to achieve a correct diagnosis. Cauda equina paragangliomas are well-encapsulated tumors that may be cured by surgery alone, whereas radiotherapy is reserved for incompletely resected tumors. Overall, prolonged postoperative observation is mandatory because of the slow tumor evolution and the possibility of tumor relapse even up to 30 years after surgery.
authors.affiliation: Department of Neurosurgery, Perugia University Medical School, Piazzale Menghini, 1 Loc. Sant'Andrea delle Fratte, 06132 Perugia, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Corinaldesi
authors.affiliation: Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy. Electronic address: federicanovegno@hotmail.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Novegno
authors.affiliation: Department of Anatomic Pathology, Perugia University Medical School, Piazzale Menghini, 1 Loc. Sant'Andrea delle Fratte, 06132 Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giovenali
authors.affiliation: Department of Diagnostics Imaging, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Lunardi
authors.affiliation: Department of Diagnostics Imaging, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Floris
authors.affiliation: Department of Neurosurgery, Perugia University Medical School, Piazzale Menghini, 1 Loc. Sant'Andrea delle Fratte, 06132 Perugia, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Lunardi
mesh_terms: D000328:Adult; D002420:Cauda Equina / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D017116:Low Back Pain / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010235:Paraganglioma / Q000473:pathology* / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Cauda equina; Filum terminalis; Paraganglioma; Radiotherapy; Recurrence; Surgery