Spinal schwannoma (cervical)

Case contributed by A.Prof Frank Gaillard

Presentation

Left upper limb weakness.

Patient Data

Age: 75 years
Gender: Female
Modality: MRI

A vividly enhancing dumbbell shaped mass extends through the C5/6 neural exit foramen along the C6 nerve root on the left. It is hyperintense on T2 weighted imaging and isointense to cord on T1. The cord is compressed and displaced to the right by the mass. 

The bony margins of the foramen are remodelled and expanded. 

Dumbbell shaped left sided mass (yellow dotted line) passes out of the neural exit foramen which it markedly expands (blue arrows). The cord is displaced towards the right (red dotted line) and has faint increased T2 signal within its substance (yellow arrow). 

Histology

 MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular tumour composed of a mixture of spindle cells and cells with small round  hyperchromatic nuclei and pale cytoplasm. Both cell types are arranged  in diffuse sheets. Collections of haemosiderin-filled macrophages are identified. Foci of dystrophic calcification are noted. No mitotic  figures are identified and there is no necrosis. Immunohistochemistry  shows strong staining in tumour cells for S-100 protein and nestin. No  staining for epithelial membrane antigen (EMA), progesterone receptor  or E-cadherin is seen in tumour cells. 

FINAL DIAGNOSIS: Spinal Neurilemmoma (Schwannoma). 

Case Discussion

This case illustrates fairly typical appearances of spinal schwannoma extending along the C6 nerve root. 

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Case Information

rID: 19694
Case created: 4th Oct 2012
Last edited: 3rd Nov 2015
Tag: spine
Inclusion in quiz mode: Included

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