Zhan et al., reported another rare case in which neurofibroma and meningioma were identified within a single dumbbell spinal tumor at the same cervical level without neurofibromatosis. Preoperative magnetic resonance imaging indicated a single extra- and intradural extramedullary dumbbell-shaped neurogenic tumor on the left ventral side of the cervical spine. Intraoperatively, they found that the mass consisted of two pathologically different tumors. The results of surgical resection were mostly satisfactory.
The present case is the first reported case of intradural neurofibroma (not meningioma) and extradural meningioma growing mixed together at the same spinal level without neurofibromatosis. The precise mechanism underlying the formation of the tumor is unknown, and multidirectional differentiation of a common progenitor cell is one possibility. Intra- and extradural exploration and component biopsies are useful for treatment planning, especially when magnetic resonance imaging is not sufficiently sensitive for diagnosing coexisting tumor types 1).
Tuberculosis has been known as the great masquerader for its varied presentations. We present an extraordinary case of a 20-year-old female who presented with paraparesis of two months. MRI showed an intradural, extramedullary dumb-bell-shaped, spinal cord tumor. With a provisional clinicoradiological diagnosis of benign nerve sheath tumor (schwannoma/neurofibroma), laminectomy was done. But after durotomy, frank pus was drained from the site of lesion and the laboratory investigations of the tissue and pus obtained proved it to be tubercular. This is a rare case reported in the literature where tuberculosis is mimicking as a dumb-bell-shaped, spinal cord tumor 2).