Sacral schwannoma

Case contributed by Adesola Abiodun Asaleye
Diagnosis almost certain

Presentation

Pelvic swelling with severe low back pain.

Patient Data

Age: 60 years
Gender: Female

Pelvis

mri
This study is a stack
Sagittal
T2
This study is a stack
Axial
STIR
This study is a stack
Axial
T1
This study is a stack
Coronal T1
C+ fat sat
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Info

A huge well-defined heterogeneous solid lesion of mixed-signal intensity is demonstrated in the pelvis, arising from the sacrum. It shows heterogeneous postcontrast enhancement. 

Case Discussion

Schwannomas are very rarely seen in the sacral region and constitute 1-5% of all spinal schwannomas. They are mostly benign lesions.

Giant invasive spinal schwannomas are masses that invade more than 2 vertebral levels, invade vertebral bodies and by extending posteriorly, reach the myofascial regions. They often present with pains and neurological symptoms.

MR findings, in this case, show a solid lesion of mixed-intensity with a heterogeneous contrast enhancement demonstrated anterior to the sacrum. It measures 14.0 x 13.1 x 9.8 cm. There is a foraminal extension of the mass with the destruction of the sacral vertebrae.

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