Diagnosis: Disturbance of skin sensation. Malignant neoplasm of spinal cordClinical question: assess thoracolumbar tumor/syrinx progressionSigns and Symptoms: progressing RLE numbness > LLE, back pain, imbalance MRI thoracic spine:There is a large complex syrinx which involves the spinal cord from the T5-6 disk space level to the conus medullaris. There appears to be a 61mmx11mm septated cystic lesion from the superior aspect of T6 down to T8-T9. On the 10/23/14 exam this cystic lesion measured 11x48mm and extended from T6-T7 to T8-9 and was not clearly present on the 2/13/2008 exam. Below and adjacent to this cystic lesion there are smaller laterally located spinal cord cystic lesions which were also present in 10/23/2014 but not on 2/13/2008. Below and adjacent those septated cystic lesions there is a larger peripherally enhancing septated cystic lesion extending from the T11-T12 level to the L1 level, measuring 51x14mm sagittal dimensions and on 3/2015 measuring 52x14mm sagittal dimensions. There is rim enhancement associate with this lesion which is thicker on the prior exam relative to the current exam. There is a soft tissue enhancing component along the inferior and right sided aspect of this lesion measuring 10x8x 14mm and previously measuring 11x15x 16mm.The patient is status post T12 and L1 laminectomies. There is a levocurvature to the lumbar spine and a dextrocurvature to the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a levocurvature to the lumbar spine. The patient is status post T12 and L1 laminectomies. There is a septated cystic lesion extending from the T11-T12 level to the L1 level, measuring 51x14mm sagittal dimensions and on 3/2015 measuring 52x14mm sagittal dimensions. There is rim enhancement associate with this lesion which is thicker on the prior exam relative to the current exam. There is a soft tissue enhancing component along the inferior and right sided aspect of this lesion measuring 10x8x 14mm and previously measuring 11x15x 16mm.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There are contiguous complex cystic lesions present within the spinal cord as a complex syrinx and an inferiorly located enhancing lesion as detailed above. The most inferior cystic lesion has peripheral enhancement and is known to represent a thoracic intradural cyst, whose soft tissue component is slightly (but measurably) smaller on the current exam when compared to the March exam. The superior most cystic lesion is larger on the current exam when compared to the October 2014 exam as described above and was not clearly present in the February 2008 exam. There are abutting laterally centered cystic lesions between the above described lesions also present on 10/23/14 but not on 2/13/08.