Presentation
The patient reports progressive low back pain, and muscle weakness in the lower limbs, accompanied by loss of sphincter control.
Patient Data
This spine MRI shows a large expansile soft tissue intradural mass at the T11-L3 level, with scalloping of the posterior contour of the L1 vertebral body suggesting slow-growing intraspinal mass. The tumor occupies most of the canal, resulting in intradural localization with extradural extension to the nerves roots foraminas, but restricted to the spinal canal.
The lesion is isointense to cord on T1-weighted imaging; it displays heterogeneous T2 hyperintense, with areas of higher signal correlating with cystic degeneration; Enhanced T1- weighted sequence demonstrates mass with irregular contrast enhancement.
Conclusion
The differential diagnosis for the intradural mass at T11-L3 is nerve sheath tumor, myxopapillary ependymoma, and meningioma.
Pathology
Histology
Macroscopic description:
Intradural content/tumor.
This tissue is a Compact, irregular, elastic, brownish-brown tissue fragments with yellowish areas, measuring the most extensive 2.2 x 0.9 x 0.5 cm.
Microscopic description:
A neoplasm with the typical histologic features of schwannoma, with Antoni type A and Antoni type B areas.
Conclusion:
Intradural T11 – L3 tumor resection: Schwannoma.
Case Discussion
Spinal schwannomas are benign nerve sheath tumors that occur within the spinal canal and are composed primarily of Schwann cells of spinal nerve roots 1-6. When they are intraspinal and extend for two or more vertebral segments, they are called giant intraspinal schwannomas 4,5.
This case illustrates the MRI findings of a giant intraspinal lumbar schwannoma, align with the long axis of the cord, forming a sausage-shaped mass, extending over several levels, and with posterior scalloping of the vertebral body. This is a case of a pathology-proven schwannoma with the typical histologic features of Antoni type A and Antoni type B areas.
Case courtesy
- Sterfferson Morais, MD - PGY-3, radiology resident, Department of Radiology
- Claudionor Segundo, MD – PGY-5, neurosurgery resident, Department of Neurosurgery
- Luiz Severo Bem Junior MD – PGY-5, neurosurgery resident, Department of Neurosurgery
- Geraldo Sá MD – neurosurgeon, Department of Neurosurgery
- Ana Lúcia A Brito MD – pathologist, Department of Pathology
- Antonio Rodrigues de Aguiar Neto, MD - radiologist, Department of Radiology
Hospital da Restauração – Recife, PE – Brazil
Unable to process the form. Check for errors and try again.