Intradural cystic schwannoma

Case contributed by Mustafa Takesh
Diagnosis almost certain

Presentation

Patient with a history of breast cancer, presented with a left periscapular pain.

Patient Data

Age: 70 years
Gender: Female

CT

ct

Selected images of CT, that was done to rule out pulmonary emboli, given the clinical presentation. No evidence of central pulmonary emboli identified. 

mri

Selected MR images demonstrating a lobulated cystic mass within the thecal sac  at T2-3 leve with a marginal enhancement and a small enhancing mural nodulel. This mass occupies nearly the entire cross-sectional area of the spinal canal, compressing and displacing the cord to the right. Despite the compression, no abnormal cord signal is identified.

There is a severe compression fracture at T5 with minimal retropulsion of the dorsal cortical margin of the vertebral body which abuts the ventral margin of the spinal cord. 

Postsurgical MRI

mri

Expected postsurgical changes related to removal of intradural/extramedullary cystic mass lesion at T2-3 level with resolution of the mass effect on the thoracic cord. Tiny reactive dural enhancement without definite evidence of residual tumor components. 

Interval development of compression fracture of T3 vertebral body without associated edema, suggesting old fracture. Evolution of the previously seen compressive compression fracture of T5 vertebral body.

Case Discussion

An uncommon case of intradural cystic schwannoma in a patient with a history of breast cancer, with some classic features, including marginal enhancement. This case shows the obvious superiority of MRI over CT. 

The histological report confirmed schwannoma WHO grade I.

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