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A large peripherally enhancing multiloculated lesion with few locules showing hemorrhage in the presacral region towards the left of mid line extending along the left sacral foramina causing its widening and scalloping of adjacent bone and reaching to the left side of the spinal canal abutting and encasing the cauda equina nerve roots
Histopathology proven case of ancient schwannoma.
Schwannomas are slow-growing benign encapsulated tumors arising from nerve sheath and usually found in the extremities
Ancient schwannoma is seen in elderly patient commonly seen in the head and neck, thorax, retroperitoneum, pelvis, and extremities and is characterized by degenerative changes showing calcification, cystic necrosis, loss of Antoni type A tissue, and degenerative nuclei on microscopy.
Due to cystic necrosis, these lesions are mistaken for the following.
- malignant fibrous histiocytoma
- malignant peripheral nerve sheath tumor
- liposarcoma, synovial sarcoma
The ancient schwannoma in our case showed a well-defined multiloculated complex cystic mass showing peripherally and septal enhancement.