Presentation
Back pain
Patient Data
There is a large ovoid mass within the thecal sac extending between the L1 and L3 levels with thick irregular peripheral enhancement. There is some peripheral susceptibility artefact with layering blood products. The upper aspect of the mass abuts the conus. The filum terminale appears to be displaced posterior to the mass, rather than incorporated within it, although this is not certain.
There is mass effect on the adjacent nerve roots which are largely compressed posteriorly and laterally and mechanical compression is evidenced by nerve root redundancy above and below the mass, and prominent of the pial veins.
Conclusion:
Large intradural mass within the thecal sac with the differential diagnosis of a cystic nerve sheath tumor (schwannoma) and myxopapillary ependymoma.
Case Discussion
The patient went on to have a resection.
Histology
MICROSCOPIC DESCRIPTION:
Sections show a moderately cellular tumor. It comprises hypercellular areas composed of fascicles of bland spindle shaped cells admixed with loosely textured relatively hypocellular areas. Occasional poorly formed verocay bodies are identified. There are scattered thick walled blood vessels within the tumor. Some scattered tumor cells show mild nuclear pleomorphism. No mitoses or necrosis is identified.
The tumor cells are strongly and diffusely S-100 positive and EMA negative.
The features are of a schwannoma. There are no features suggestive of a myxopapillary ependymoma.
FINAL DIAGNOSIS: spinal schwannoma.
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