Spinal schwannoma (cervical)

Case contributed by Frank Gaillard


Two week history of increasing neck and right arm pain.

Patient Data

Age: 60 years
Gender: Female

A vividly-enhancing 2.7 cm (L) x 1.2 cm x 1.4 cm (D) heterogeneous T2 hyperintense intradural / extramedullary mass, with broad dorsal dural base (but no dural tail) is centered in the right side of the mildly expanded spinal canal at C2 and C3.  This severely compresses and displaces the mildly hyperintense spinal cord to the left, with increased epidural enhancement noted to extend along the right C3-C5 nerve roots. 

The resultant severe spinal canal stenosis extending from C2 to C3/4 is further compounded by a contained 5 mm diameter C3/4 superiorly-projecting central posterior to right paracentral disc extrusion. 

A vividly-enhancing 2-3 cm isointense extra-axial mass, compatible with a globular meningioma, is partially imaged posteriorly in the left posterior fossa.  This extends superiorly across the tentorium cerebelli, indenting the posterior left cerebellar hemisphere and inferior occipital lobe, with mild adjacent vasogenic edema. 

Annotated image

The extramedullary intradural mass ( * ) which is high on T2 and demonstrated vivid contrast enhancement, markedly displaces and compresses the cord (blue dotted line) to the left. Above the lesion the cord is edematous (yellow arrow) which is further accentuated by a contained focal disc extrusion (green arrow). 

In the posterior fossa a meningioma (M) is seen abutting the inferior aspect of the tentorium and invading the transverse sinus (red arrow). 

The patient went on to have a laminectomy and tumor resection. A number of months later they also underwent a posterior fossa craniotomy and excision of the second tumor. 

Spinal mass histology

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

FINAL DIAGNOSIS: Spinal tumor: Schwannoma.

Posterior fossa mass histology

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumor comprises mainly

fascicles.  The tumor cells have ovoid nuclei with no significant nuclear pleomorphism. Mitoses are inconspicuous.  There is no necrosis. No brain parenchyma is included in the biopsy.  There is no atypical or malignant change. 

FINAL DIAGNOSIS: Posterior fossa: Meningioma (WHO Grade I).

Case Discussion

This case demonstrates fairly typical appearances of a large spinal schwannoma with an incidental posterior fossa meningioma. 

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