Spinal schwannoma and renal cell carcinoma

Case contributed by Dr Craig Hacking

Presentation

Back pain

Patient Data

Age: 40 years
Gender: Male

Intradural extramedullary mass at the level of L1/2 extending from the level of the conus measuring 16 x 13 x 37 mm (LR x AP x SI). The conus terminates at L1. The mass is isointense to cord on T1 and demonstrates vivid fairly homogeneous contrast enhancement. The mass displays heterogeneous T2 signal - predominately slightly hyperintense to cord with some more hyperintense foci. The lesion occupies most of the canal resulting in splaying and compression of the traversing cauda equina nerve roots. No appreciable dural tail or extension into the intervertebral foramina. No other mass or abnormal enhancement detected in the spinal canal.

There is a wedge compression fracture of the L2 vertebral body associated with moderate loss of height. Vertebral body height is otherwise maintained. Alignment of the imaged spine is intact. Elsewhere, the canal is capacious and there is no intervertebral foraminal stenosis.

There is a partially imaged complex predominantly T2 hyperintense mass in the superior pole of the right kidney measuring 4.3 x 3.1 cm.

Conclusion

The differential diagnosis for the intradural extramedullary mass at L1/2 is meningioma, nerve sheath tumour and myxopapillary ependymoma. This results in cauda equina compression.

Incompletely imaged right renal mass is highly suspicious for RCC. Taking this into account, the possibility of a dural metastasis is raised although considered far less likely.

Case Discussion

Histology = schwannoma

CT abdo showed RCC right kidney.

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Case information

rID: 42001
Case created: 31st Dec 2015
Last edited: 27th Sep 2017
System: Spine
Inclusion in quiz mode: Included

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