Spinal schwannoma - cervical

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Left upper limb weakness.

Patient Data

Age: 75 years
Gender: Female
mri
This study is a stack
Sagittal
T2
This study is a stack
Sagittal
T1
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial
T2
This study is a stack
Axial
T1
This study is a stack
Axial T1
C+ fat sat
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Info

A vividly enhancing dumbbell shaped mass extends through the C5/6 neural exit foramen along the C6 nerve root on the left. It is hyperintense on T2 weighted imaging and isointense to cord on T1. Spinal cord compression with displacement to the right by the mass. 

The bony margins of the foramen are remodeled and expanded. 

Annotated image
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Dumbbell shaped left sided mass (yellow dotted line) passes out of the neural exit foramen which it markedly expands (blue arrows). The cord is displaced towards the right (red dotted line) and has faint increased T2 signal within its substance (yellow arrow). 

Histology

 MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular tumor composed of a mixture of spindle cells and cells with small round  hyperchromatic nuclei and pale cytoplasm. Both cell types are arranged  in diffuse sheets. Collections of hemosiderin-filled macrophages are identified. Foci of dystrophic calcification are noted. No mitotic  figures are identified and there is no necrosis. Immunohistochemistry  shows strong staining in tumor cells for S-100 protein and nestin. No  staining for epithelial membrane antigen (EMA), progesterone receptor  or E-cadherin is seen in tumor cells. 

FINAL DIAGNOSIS: Spinal Neurilemmoma (Schwannoma). 

Case Discussion

This case illustrates fairly typical appearances of spinal schwannoma extending along the C6 nerve root. 

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