Presentation
CT urography for right flank pain
Patient Data
CT urography demonstrates a 3 mm calculus in the distal part of right ureter with proximal ureter dilatation.
Incidentally, an expansile soft tissue mass is seen at T12 / L1 level extending into the left intervertebral foramen. The lesion also causes marginal sclerosis and foraminal remodeling consistent with a chronic lesion.
The patient went on to have MRI of spine for further evaluation of the soft tissue mass.
This MRI spine demonstrates an expansile soft tissue mass (extradural) lesion at T12/L1 level expanding into the left intervertebral foramen. It is T2 hyperintense and T1 hypointense. It is also enhanced with contrast.
Case Discussion
The patient went on to have a left hemilaminectomy and excision of an extradural tumor. Intra-operatively, the lesion was noted to erode through anterior vertebral body with the T12 nerve root traveling through the lesion. It derived its blood supply from the intercostal artery.
Histology
MACROSCOPIC DESCRIPTION:
Left T12/L1 extradural content/tumor: Six pieces of firm white to hemorrhagic tissue
MICROSCOPIC DESCRIPTION:
Sections demonstrate a benign spindled lesion. The lesion shows broad areas of sclerosis and low cellularity as well as focal Verrocay bodies. Hyalinised vasculature is noted. An occasional enlarged and hyperchromatic cell nucleus is present, however no necrosis is seen and the mitotic rate is not elevated. A nerve ganglion is seen at the lesion edge.
DIAGNOSIS: Schwannoma.
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