Журнал позвоночника и нейрохирургии

Lumbar Spine Lymphoplasmacytic-Rich Meningioma-The First Case of Literature

Luis Cardoso*, Ricardo Nogueira, Lino Fonseca, Pedro Branco, Bernardo Smet and Pedro Roque

Objective: Lymphoplasmacytic-rich meningioma (LPRM) is a very rare benign subtype. Occurs mostly in cerebral convexities, skull base, parasagittal tentorial area and cervical spinal canal. There isn´t any report of cases below to the cervical spine. The authors propose to present a very rare case of a patient with lumbar spine
Lymphoplasmacytic-rich meningioma operated.

Methods: We report a 39 years male patient with intense and fast progressive low back pain, refractory to medication. The pain had left inguinocrural irradiation, without neurological deficits. A Lumbar MRI was performed and shows an expansive intracanalar lesion, left-lateralized and occupying the left L1-L2 foramen.
The patient was operated and was performed an L1 inferior laminotomy with flavectomy to approach the lesion. An inner longitudinal durotomy was made and the lesion was meticulously removed including the dura and dissecting the L1 root without a change in the EMG pattern.

Results: The low back pain healed but persistent paresthesia at left-L1 remained for 6 months. The histopathological evaluation revealed that the meningothelial component was partially obscured by a dense chronic inflammatory infiltrate. The lymphoid, plasmacytoid and meningothelial components identified. The
patient maintains the follow-up, and at 7 years has not any symptom or neurologic deficit, or recurrence.

Conclusions: Lymphoplasmacytic-rich meningioma is a very rare subtype of meningioma, distinguished by massive inflammatory cell infiltration and often a low concentration of meningothelial tumorous elements. The spine location is rarest. The main and more effective treatment remains the surgical resection with
favorable clinical outcomes in most cases, which is confirmed by the long follow-ups, without the use of Radiotherapy. This paper has special relevance because describes the first case of lumbar spine Lymphoplasmacytic-rich meningioma published.