A Case Report of an Intradural Extramedullary Tumor, Which Was Treated With Steroid and Clinically Suspected as...

Sarcoidosis is a systemic disease that is represented by lymph node swelling of the lung with pathologically diagnosed nonfibromatous necrosis. We report a rare case that was clinically diagnosed as an intradural extramedullary tumor of sarcoidosis, which was treated with oral steroid medication. A 45-year-old woman visited a local clinic due to leg pain and muscle weakness. MRI showed an intradural extramedullary tumor at the level from Th 4 to 5. The radiologist's comment on MRI suggested that the tumor was a meningioma. She was referred to our hospital for emergency surgery due to muscle weakness. On administration, the muscle strength was Grade 4 on manual muscle testing and no bladder or rectal disorder was observed. The appearance of the tumor was not typical for the diagnosis of meningioma and the prior diagnosis could be neural sarcoidosis or a hematologic tumor as differential diagnoses. Lab data and bone marrow aspiration did not prove a hematologic tumor. CT revealed bilateral hilar lymphadenopathies, whereas pathological examination by bronchoscopy did not show evidence of sarcoidosis, such as caseating granuloma. Since resection of intradural tumors carries a high risk of complications, the mass was clinically suspected as sarcoidosis and treatment of the tumor with steroid started. After treatment, the pain and muscle weakness diminished soon, and 2 months later, the tumor clearly disappeared. In the follow-up period, she also suffered heart sarcoidosis and continued steroid therapy for heart problems. If intradural extramedullary sarcoidosis was diagnosed before surgery, patients do not need surgery. It is important for surgeons to know this disease.