Schwannoma

Case contributed by A.Prof Frank Gaillard

Presentation

Sciatica.

Patient Data

Age: 39
MRI

At the level of the L1/2 intervertebral disc, there is an intra-dural extra-medullary ovoid lesion which demonstrates mild heterogeneous T2 hyperintensity. The lesion is avidly enhancing, with a central non-enhancing component corresponding to internal T2 hyperintense foci. There is an significant mass effect on the tip of the conus and proximal filum which are displaced anterolaterally to the left. Several cauda equina nerve roots are compressed over the right posterolateral aspect of the lesion. No other lesion identified.

L2/3 disc degeneration with a small right para central disc protrusion and annular fissure not resulting in significant canal stenosis. L2 vertebral body hemangioma noted.

Conclusion:

Intra-dural extra-medullary lesion at the level of the L1/2 intervertebral disc consistent with a schwannoma with compression of the distal conus, filum and cauda equina.

Case Discussion

The patient went on to have a resection. 

Histology

MICROSCOPIC DESCRIPTION: Sections show a spindle cell tumor demonstrating variable cellularity. Hypercellular (Antoni A) areas are composed of short fascicles of tumor cells with focal nuclear pallisading (Verocay bodies). Hypocellular areas (Antoni B) show loose edematous and fibrillary stroma. Tumor cells contain bland wavy nuclei. There are scattered thin walled hyalinised blood vessels present. No necrosis or mitoses are seen. There is no evidence of atypia or malignancy.

DIAGNOSIS: Spinal schwannoma.

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Case information

rID: 44971
Published: 11th May 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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