A 45-year-old woman in Japan was sent to a university hospital for possible urgent spinal surgery after an MRI showed a mass inside her spinal canal. Her surgeons held off. They treated her with steroids instead, and within two months the mass had disappeared.
It did not stay gone. Over the next two years, it returned twice, vanishing each time with more steroids, and she was eventually diagnosed with sarcoidosis in her heart. More than six years later, she has never had spinal surgery and reports no pain or numbness.
The orthopedic team at Nagoya City University Graduate School of Medical Sciences described the case in June 2026 in Case Reports in Orthopedics. They clinically suspected the mass was neural sarcoidosis, an inflammatory disease, rather than a true tumor.
Numbness, Weakness and a Mass Read as a Meningioma
Her first symptoms were reduced sensation and numbness in her right lower leg. After five months, a local orthopedic clinic gave her medications including vitamin B12. Two months later, her leg muscles weakened, and a brain MRI found nothing wrong.
Spinal imaging finally revealed an intradural extramedullary mass at the level of the fourth and fifth thoracic vertebrae in the mid-back. The term means the growth sat inside the protective membrane around the spinal cord but outside the cord itself. The radiologist suggested it was a meningioma, a usually benign tumor that often requires removal.
On admission, some of her leg muscles were moderately weak, her reflexes were exaggerated and she had rhythmic ankle jerking on both sides, signs consistent with a problem in the thoracic spine. She had no bladder or bowel problems.
Why Surgeons Chose Steroids First
The surgeons thought the horseshoe-shaped mass looked too soft and irregular for a typical meningioma. They considered two other possibilities: an inflammatory mass such as sarcoidosis or a blood cancer.
Blood tests and a bone marrow aspiration found no evidence of a blood cancer. A CT scan showed masses near the lungs' central airways on both sides, a pattern often seen in sarcoidosis, but a bronchoscopy biopsy did not find the granulomas that usually confirm the disease. Exams found no heart, eye, or skin involvement at the time, so she did not meet formal diagnostic criteria.
The only remaining route to a definitive diagnosis was spinal surgery, which carries risks including infection, spinal fluid leaks, and paralysis. After 26 days of observation, the team started prednisolone at 45 mg a day without a biopsy of the mass.
Her numbness and weakness improved within two days, and her strength fully recovered after 10 days. Two months later, MRI showed the mass had clearly disappeared. The steroids were tapered and stopped after five months.
Two Relapses and a Heart Diagnosis
One year after her first visit, a follow-up MRI showed the mass had returned in the same spot, although she had no symptoms. A lower steroid dose made it disappear again within four months, but weight gain and a rounded moon face led doctors to taper and stop the drug.
Two years after her first visit, the mass came back once more. At the same time, she was clinically diagnosed with cardiac sarcoidosis after fluid built up around her heart. Cardiologists eventually raised her prednisolone to 30 mg a day, and the spinal mass vanished again within four months. With steroids managed by her cardiologists since then, it has not returned.
Relapses like hers have been described before. The authors highlight a 30-year-old woman with a similar mass whose disease recurred six months after surgery and required steroids, which led those authors to describe spinal sarcoidosis as a pattern of remission and relapse.
An Uncommon Form of an Uncommon Disease
Sarcoidosis causes clusters of immune cells called granulomas to form in organs, most often the lungs and lymph nodes. Diagnosing it is not straightforward. An American Thoracic Society guideline cited by the authors notes that no objective measures establish whether diagnostic criteria are met, so the diagnosis is never fully secure.
Masses like hers, inside the spinal membranes but outside the cord, are unusual. Previously reported cases were diagnosed only after surgery, the authors wrote. Examples include a cervical spine case first read as a meningioma and a 32-year-old man whose mass mimicked a meningioma. To the authors' knowledge, no earlier report described such a mass being treated successfully with steroids alone.
The diagnosis still carries a major caveat. Because the mass was never biopsied, it remains clinically suspected rather than proven, as the report's title makes clear.
The case does not mean spinal masses should routinely be treated with steroids instead of surgery. Many spinal tumors, including meningiomas, require removal, and steroids are not a substitute for a diagnosis. Long-term steroid use also carries its own risks, as her side effects showed. The authors' message is narrower: when a mass looks unusual, and other clues point to sarcoidosis, considering the disease may spare some patients an operation.
Anyone with progressive back or leg pain, weakness, numbness, or new bladder or bowel problems should be evaluated promptly, since spinal cord compression can require urgent care.
Key Questions Answered
What did the MRI show?
It showed a horseshoe-shaped mass in the thoracic spine, inside the spinal membranes but outside the cord. A radiologist suggested it was a meningioma.
Why didn't doctors operate?
The mass looked atypical; chest scans suggested sarcoidosis, and surgery on masses in that location carries serious risks, so doctors tried steroids first.
What happened after steroids?
Her symptoms improved within two days, and the mass disappeared within two months. It returned twice over two years and disappeared again each time with steroids.
Was sarcoidosis confirmed?
Not by biopsy of the mass. The diagnosis remains clinically suspected, and she was later diagnosed with cardiac sarcoidosis.
Can steroids replace surgery for spinal tumors?
Generally no. This case involved a suspected inflammatory mass, and treatment de
Published by Medicaldaily.com
