Spinal schwannoma - cervical

Case contributed by Dr Bruno Di Muzio

Presentation

Chronic cervicogenic headache.

Patient Data

Age: 55 years
Gender: Female

MRI Cervical spine

MRI

Dumbbell in configuration iso-high heterogenous T2 with corresponding iso-low T1signal mass seen with mildly heterogenous enhancement following IV contrast involving the left C2/3 neural exit foramen. The focus extends to the central spinal canal with significant displacement of the spinal cord towards the right side but without abnormal spinal cord signal change. There is bony widening to the involved neural exit foramen with the lesion abutting the left vertebral artery.

Note is made of a right-sided rounded homogeneous enhancing acoustic neuroma at the level of the right internal auditory meatus. There is no intracanalicular component.

Fluid demonstrated within the right mastoid air cells suggestive of mastoiditis.

Patchy bone marrow present due to a combination of fatty and red marrow.

CTA neck - preoperative imaging

CT

 

Left C2/C3 neural exit foraminal widening demonstrated as a result of underlying faintly enhancing tumor. Significant remodeling and thinning demonstrated of left C2 and C3 pedicles and laminae. The left vertebral artery remains patent throughout its entire length.

MICROSCOPIC DESCRIPTION: 1-3. The sections show a moderately cellular schwannoma. It mainly contains Antoni A areas comprising fascicles of spindle cells with palisading. Verocay bodies are noted. A small amount of Antoni B areas with microcystic change is also seen. The cells show no significant nuclear pleomorphism. Mitoses are inconspicuous. There is no evidence of necrosis. No evidence of malignancy is identified.

DIAGNOSIS: tumor: Schwannoma

Case Discussion

Typical imaging features of a spinal schwannoma: solid well-defined lesions with low T1 and high T2 MRI signals, and showing contrast enhancement. The signal intensity is slightly heterogeneous due associated small central necrosis/cystic formation. incidental right internal acoustic meatus presumed acoustic neuroma. 

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