Presentation
Progressive weakness of the lower extremities. Concern for mass versus upper motor lesion.
Patient Data
At the level of T11/T12 intervertebral disc space, there is a well-defined, ovoid, ventral intradural, extramedullary enhancing mass. This mass is T1/T2 isointense, STIR hyperintense, and demonstrates some with some internal cystic signal. This lesion significantly indents the thoracic spinal cord, resulting in severe mass effect and increased intramedullary STIR signal. The mass has an adjacent T2 flow void.
Case Discussion
This is a case of a spinal schwannoma.
The patient underwent resection to decompress the thoracic spinal cord. Histopathology revealed a bland spindle cell neoplasm with hyalinized vessels and microcystic changes. Verocay bodies were readily identifiable. Mitotic figures and tumor necrosis were not visualized. An intralesional axonal component was not evident. Immunohistochemical stains showed that the lesional cells were diffusely strongly positive for S100 and SOX10. The neurofilament stain identified nerve fascicles at the periphery of the lesion. CD34 stain revealed vasculature. These pathologic findings are consistent with schwannoma.
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