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Li Y, Li Y, Liu J, Pang C, Li C. Concurrent spinal meningioma and giant invasive schwannoma without neurofibromatosis in children: A case report and literature review. Childs Nerv Syst 2024; 40:1623-1630. [PMID: 38349526 DOI: 10.1007/s00381-024-06300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/23/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Spinal meningiomas coexisting with schwannomas in patients without neurofibromatosis are extremely rare lesions. There were only 15 cases reported to date, which were concurrent intradural tumors of different pathological types. CASE PRESENTATION Herein, we present a rare case of a 15-year-old child with concurrent spinal dorsal meningioma and ventral giant invasive schwannoma at C7-T3 and T10-S5 spinal levels. Preoperative magnetic resonance imaging and computed tomography indicated the schwannoma across the thoracic and lumbosacral transitional vertebra, with extensive bony erosion of the sacrum. The results of surgical resection were mostly satisfactory. CONCLUSIONS The present case is the youngest patient diagnosed with concurrent intradural tumors at different spinal levels. The pathogenetic mechanism remains unclear. The clinical presentations are always atypical. Surgical resection of the tumors is the first choice. We use the non-fusion surgery to preserve the function of the lumbar spine.
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Affiliation(s)
- Yaxiong Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China.
| | - Yan Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
| | - Jianfeng Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
| | - Chao Pang
- Department of Pathology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Conghui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
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Zheng GB, Hong Z, Wang Z. Diagnostic value of MRI in coexistence of schwannoma and meningioma mimicking a single dumbbell-shaped tumor in high cervical level. Case series and literature review. J Spinal Cord Med 2023; 46:326-331. [PMID: 34612798 PMCID: PMC9987764 DOI: 10.1080/10790268.2021.1977062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Concurrent schwannoma and meningioma arising in the high cervical level mimicking a single dumbbell-shaped tumor is significantly rare, most of them were found during the surgeries or postoperative histological findings unexpectedly. The specific feature of schwannoma and meningioma coexistence in high cervical level on MR images has not been clearly described yet. FINDINGS We presented four cases of concurrent extradural schwannoma and intradural meningioma mimicking a single dumbbell-shaped tumor arising in the high cervical level. There was no interconnection between intradural and extradural masses in any case. In MRI reviews, the signal intensity between intradural lesions and spinal cord was similar on T2 weighted MR images. However, on contrast-enhanced MR images, the intradural lesions were more enhanced than spinal cord and presented as crescent-shaped intradural minor lesions adjacent to the more significantly enhanced extradural major tumor. These MRI findings could not be easily identified without meticulous observation preoperatively. Postoperative pathological findings confirmed the discrete tumors arising in the same cervical level. CONCLUSION The comparison of signal intensity changes among the spinal cord, intradural tumor and extradural tumor between T2 weighted and contrast-enhanced MR images may be helpful to predict coexistent schwannoma and meningioma in the high cervical level preoperatively. Intradural exploration is highly recommended when less enhanced crescent-shaped intradural minor lesion was observed adjacent to the significantly enhanced dumbbell-shaped major tumor in preoperative MRI findings.
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Affiliation(s)
- Guang Bin Zheng
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, People's Republic of China
| | - Zhenghua Hong
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, People's Republic of China
| | - Zhangfu Wang
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, People's Republic of China
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Zhao LY, Jiang YN, Wang YB, Bai Y, Sun Y, Li YQ. Coexistent vestibular schwannoma and meningioma in a patient without neurofibromatosis: A case report and review of literature. World J Clin Cases 2021; 9:7251-7260. [PMID: 34540986 PMCID: PMC8409193 DOI: 10.12998/wjcc.v9.i24.7251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The simultaneous occurrence of schwannoma and meningioma in the absence of neurofibromatosis (NF) or a previous history of irradiation is exceedingly rare, as only 10 intracranial cases have been reported to date. Herein, we report a case of a coexistent cavernous sinus meningioma and ipsilateral vestibular schwannoma (VS) in a female patient without NF or a history of exposure to irradiation. CASE SUMMARY A 63-year-old woman presented with progressive left-side hearing loss and tinnitus over the previous year. In the past 6 mo, she developed facial numbness and intermittent headaches. Magnetic resonance imaging showed two lesions that were located on the left side of the cerebellopontine angle and parasellar region. Both lesions were totally resected via the left retrosigmoid approach. Histopathological examination revealed a VS and a meningioma. The patient did not have a family history or clinical or radiological signs of NF. CONCLUSION The coincident occurrence of VS and meningioma within close vicinity is very rare, and the pathogenesis is unclear. A careful whole-body examination needs to be conducted to exclude NF. Surgical treatment with the goal of total tumor resection is the best therapy. Additional studies are needed for a better understanding of the mechanisms that lead to the development of tumor growth in multiple locations.
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Affiliation(s)
- Li-Yan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Yi-Ning Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Yun-Qian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Suematsu Y, Tsuji O, Nagoshi N, Nori S, Suzuki S, Okada E, Yagi M, Kameyama K, Fujita N, Watanabe K, Nakamura M, Matsumoto M. Concurrent dorsal subpial schwannoma and ventral meningioma arising at the same upper cervical level: a case report. Spinal Cord Ser Cases 2020; 6:64. [PMID: 32669553 DOI: 10.1038/s41394-020-0308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Multiple spinal cord tumors rarely occur without genetic predisposition, and concurrent tumors with discrete pathologies developed at the same spinal level are most rare. Here, we report a case of concurrent dorsal schwannoma and ventral meningioma arising at the same upper cervical level (C1-C2). CASE PRESENTATION A 55-year-old woman presented with neck pain and upper and lower extremity numbness for 1 year. Magnetic resonance imaging of the cervical spine showed a partially circumferential C-shaped intradural extramedullary tumor at C1-C2. The preoperative diagnosis based on imaging was intradural extramedullary meningioma with circumferential development. Surgical resection was performed, and dorsal subpial and ventral tumors were detected. Intraoperative pathological diagnosis was schwannoma for the dorsal tumor and meningioma for the ventral tumor. Both tumors were completely resected, followed by circumferential durotomy and duroplasty (Simpson grade 1 resection). Although symptoms related to cerebrospinal fluid hypovolemia occurred immediately after surgery, they disappeared within several days. At 2 years postoperatively, no local recurrence has been identified with mild kyphotic cervical malalignment. DISCUSSIONS Only nine cases of concurrent multiple spinal tumors with discrete histopathological types at the same cervical level have been reported to date, however, this is the first case of meningioma combined with subpial schwannoma. Furthermore, although the ventral location of meningioma often compelled inadequate resection leaving behind a dura mater from which meningioma originated, a gross total resection including dura mater was achieved accompanied with circumferential duroplasty. Careful and sequential postoperative follow-up is ongoing for this individual.
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Affiliation(s)
- Yu Suematsu
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Zhan Z, Yan X, Nie W, Ding Y, Xu W, Huang H. Neurofibroma and Meningioma within a Single Dumbbell-Shaped Tumor at the Same Cervical Level without Neurofibromatosis: A Case Report and Literature Review. World Neurosurg 2019; 130:1-6. [PMID: 31254713 DOI: 10.1016/j.wneu.2019.06.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cases of multiple intracranial tumors are common; however, cases of multiple intraspinal tumors are rare. Except for cases of neurofibromatosis, it is very rare for tumors of different pathological types to exist concurrently at the same spinal level. Only 9 cases have been reported to date, with meningioma found with schwannoma in 7 cases and with neurofibroma in 2 cases. CASE DESCRIPTION We have reported another rare case in which neurofibroma and meningioma were identified within a single dumbbell-shaped tumor at the same cervical level without neurofibromatosis. The preoperative magnetic resonance imaging findings indicated a single extra- and intradural extramedullary dumbbell-shaped neurogenic tumor on the left ventral side of the cervical spine. Intraoperatively, we found that the mass consisted of 2 pathologically different tumors. The results of surgical resection were mostly satisfactory. CONCLUSIONS To the best of our knowledge, the present case is the first reported case of intradural neurofibroma (not meningioma) and extradural meningioma growing mixed together at the same spinal level without neurofibromatosis. The precise mechanism underlying the formation of the tumor is unknown, and multidirectional differentiation of a common progenitor cell is one possibility. Intra- and extradural exploration and component biopsies are useful for treatment planning, especially when the magnetic resonance imaging is not sufficiently sensitive for the diagnosis of coexisting tumor types.
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Affiliation(s)
- Zhixin Zhan
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xu Yan
- Pathlological Diagnostic Center, First Hospital of Jilin University, Changchun, China
| | - Weiguang Nie
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yaonan Ding
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Weidong Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Haiyan Huang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
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Matsuda S, Kajihara Y, Abiko M, Mitsuhara T, Takeda M, Karlowee V, Yamaguchi S, Amatya VJ, Kurisu K. Concurrent Schwannoma and Meningioma Arising in the Same Spinal Level: A Report of Two Cases. NMC Case Rep J 2018; 5:105-109. [PMID: 30327752 PMCID: PMC6187259 DOI: 10.2176/nmccrj.cr.2017-0207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
Concurrent multiple tumors developing in the spinal cord are rare, except for in genetic disorders, such as neurofibromatosis and von Hippel-Lindau disease. Furthermore, concurrent tumors arising in the same spinal level with discrete histopathology are much rarer. We report two such cases. Case 1: A 53-year-old man presented with intracranial hemorrhage that manifested as disturbed consciousness and right hemiparesis. Magnetic resonance (MR) angiography demonstrated severe stenosis of the terminal portion of the bilateral internal carotid arteries, implying Moyamoya disease. Cranial MR images showed a hematoma in the left basal ganglia perforating into the lateral ventricle, which was incidentally detected as a spinal tumor compressing the cervical cord at the C2 level. After conservative management for cerebral hemorrhage, the patient underwent total removal of the spinal tumor. Surgical findings showed that the tumor consisted of extra- and intradural components. Histopathological findings showed that the extra- and intradural components were schwannoma and meningioma, respectively. Case 2: A 70-year-old man presented with progressive left hemiparesis and numbness in both lower extremities. Craniocervical MR images demonstrated a paraspinal tumor compressing the spinal cord at C2 level. Surgical findings disclosed that the tumor consisted of major extradural- and minor intradural components. Histopathological study showed that these components had discrete histological findings: extradural lesion was schwannoma and intradural lesion was meningioma. Concurrent tumors with discrete histopathology should be considered in tumors with extra- and intradural components, particularly, when they are located in the high cervical spine.
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Affiliation(s)
- Shingo Matsuda
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Yosuke Kajihara
- Department of Neurosurgery, Itsukaichi Memorial Hospital, Hiroshima, Hiroshima, Japan
| | - Masaru Abiko
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Masaaki Takeda
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Vega Karlowee
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Satoshi Yamaguchi
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
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