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Terrapon APR, Stienen MN, Veeravagu A, Fehlings M, Bozinov O, Hejrati N. Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor. BRAIN & SPINE 2024; 4:102843. [PMID: 38947985 PMCID: PMC11214289 DOI: 10.1016/j.bas.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
Introduction Cystic schwannomas have only been reported in a few case reports/series. As a result, they may be misdiagnosed and a standardized management approach remains challenging to establish. Research question The aim of this study was to compile all reported cases of cystic schwannomas and analyze the perioperative course based on a systematic review of the literature with an additional two cases from the authors' experience. Material and methods We conducted a search of MEDLINE and CENTRAL databases for spinal intradural extramedullary cystic schwannomas, in accordance to the PRISMA statement. All title/abstracts were screened, and a full-text review of the remaining articles was conducted. The results were compiled in tables and summarized using means and standard deviation (SD), median and interquartile range, and percentage and 95% confidence intervals. Results We identified 263 articles, of which 35, which reported 54 cases, were included. Including our case-reports (n = 56), patients had a mean age of 47.7 years (SD ± 13.0 years) at presentation, 57% were males, and most lesions were lumbar (43%). The most common symptoms were pain (82%) and muscle weakness (68%) with 84% of patients showing neurological findings. 70% of patients showed a complete relief of symptoms after surgery and 96% reported improvement. Only four complications were reported. Discussion and conclusion Schwannomas should be considered in the differential diagnosis of intradural extramedullary cystic lesions. Patients typically present with subacute to chronic pain and/or neurologic changes. Surgical resection is the primary therapeutic modality and usually has a good to excellent outcome.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
- Department of Neurosurgery, Bern University Hospital, Rosenbühlgasse 25, 3010 Bern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Oliver Bozinov
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Nader Hejrati
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
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Colonna MR, Costa AL, Mastrojeni C, Rizzo V, Nirta G, Angileri FF, Ieni A, Milone E, Macrì A. Giant sacral schwannoma excised under intraoperative neuromonitoring in an elderly patient: case report. J Surg Case Rep 2021; 2021:rjab460. [PMID: 34733472 PMCID: PMC8560204 DOI: 10.1093/jscr/rjab460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
Schwannomas are mainly benign tumors arising from the Schwann cells of the peripheral nerve sheath. These tumors can often be associated with non-specific symptoms, such as abdominal heaviness. In this article, we present a detailed description of the surgical management of a giant sacral schwannoma in an elderly patient, for which intraoperative neuromonitoring made it possible to distinguish easily the nerves of the sacral plexus from which the tumor originated and to remove it without complications. Treatment of these rare and symptomatic giant tumors is still a challenge for surgeons; to treat adequately these tumors; a multidisciplinary approach is required to ensure an optimal therapeutic approach to reduce the risk of recurrence and, on the other hand, is not associated with unnecessary iatrogenic neurological damage.
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Affiliation(s)
- Michele R Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Alfio L Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Claudio Mastrojeni
- Unit of Vascular Surgery, CardioVascular and Thoracic Department, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Sperimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Nirta
- U.O.C. Radiodiagnostic, University of Messina, Messina, Italy
| | - Filippo F Angileri
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Antonio Ieni
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
| | - Erica Milone
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
| | - Antonio Macrì
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
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Samman AM, Bardeesi AM, Alzahrani MT. Thoracic cystic schwannoma: case report and review of literature. Spinal Cord Ser Cases 2021; 7:7. [PMID: 33468989 DOI: 10.1038/s41394-020-00376-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/21/2020] [Accepted: 12/25/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Schwannomas are the second most common type of intra-dural lesions involving the thoracic spine. They are frequently seen as solid and heterogeneous lesions. Totally cystic thoracic schwannomas represent a rare pathological schwannoma variant, with only four cases reported in the English literature to our knowledge. CASE PRESENTATION We report an 80-year-old male who presented with upper back pain for 3 months. Magnetic resonance imaging (MRI) showed a cystic lesion at the level of T6-T7 with peripheral contrast enhancement. The lesion was removed in total surgically with complete resolution of the patient's symptoms. DISCUSSION The diagnosis of cystic schwannomas is often delayed due to the paucity of symptoms and the lack of meticulous investigation. The presence of rim enhancement on contrast-enhanced MRI may be the only clue for the diagnosis. It is important to consider cystic schwannomas in the differential diagnosis of cystic spinal lesions since the best surgical outcome is strongly related to earlier diagnosis and total resection of the lesion.
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Affiliation(s)
- A M Samman
- Section of Neurosurgery, Department of Surgery, King Abdulaziz Medical city National Guard Health Affairs, Western Region, Jeddah, Saudi Arabia.
| | - A M Bardeesi
- Section of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Center (Gen. Org) - Jeddah Branch, Jeddah, Saudi Arabia
| | - M T Alzahrani
- Section of Neurosurgery, Department of Surgery, King Abdulaziz Medical city National Guard Health Affairs, Western Region, Jeddah, Saudi Arabia.,Neurosurgery College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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4
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Jung GS, Lee YM, Kim YZ, Kim JS. Intratumoral Hemorrhage of the Cervical Spinal Schwannoma Presenting: Acute Quadriparesis. Brain Tumor Res Treat 2019; 7:160-163. [PMID: 31686450 PMCID: PMC6829079 DOI: 10.14791/btrt.2019.7.e34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.
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Affiliation(s)
- Gyu Seo Jung
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Min Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Soo Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Gotecha S, Punia P, Patil A, Chugh A, Kotecha M, Raghu V, Mubashshir A, Shobhit C, Kashyap D. A Rare Chronic Presentation of Schwannoma with Hemorrhage. Asian J Neurosurg 2019; 14:897-900. [PMID: 31497123 PMCID: PMC6703075 DOI: 10.4103/ajns.ajns_277_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spinal schwannomas are slow-growing benign tumors arising from the nerves. In the spinal cord, they arise most commonly from cervical and lumbar levels. They are mostly intradural extramedullary (IDEM) accounting for 30% of intradural tumors showing a female preponderance. They are seen occurring between 25 and 50 years of age. Most of these cases show acute presentation as hemorrhage within the tumor with weakness. This is a rare presentation by itself reported by only 12 cases world over. It is even rarer to see them show chronic presentation. We are reporting one such case of a 61-year-old female who presented to us with chronic low backache for 3 years with radicular symptoms in the bilateral lower limbs following a fall on her back. Magnetic resonance imaging was done which showed a well-defined IDEM lesion from L3 to L5 vertebral level which was isointense on T1 and hyperintense on T2 with a peripheral rim and short inversion time inversion-recovery showed fluid-fluid level within. Gradient-recalled echo showed blooming with no suppression on fat-sat and no diffusion restriction. A computed tomography angiography was done which ruled out vascular malformation. Intraoperatively, a large feeding vessel with a tumor was visualized after laminectomy was done for the corresponding levels. Postoperatively, the patient showed a significant decrease in radicular symptoms and was discharged after 2 weeks with an uneventful postoperative period. HPE of the lesion showed sheets of fascicles of elongated spindle cells arranged in loose myxoid matrix with hyperchromatic nuclei and scanty hemorrhage and lymphocytic infiltrates suggestive of schwannoma with myxoid degeneration. Immunohistochemistry also confirmed a diagnosis of schwannoma. From this case, it is seen that the diagnosis of a spinal schwnnoma showing delayed presentation with atypical imaging findings is a challenge and must needs a high index of suspicion and appropriate surgical planning.
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Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Anil Patil
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Ashish Chugh
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Megha Kotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Vybhav Raghu
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Ali Mubashshir
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Chhabra Shobhit
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Dushyant Kashyap
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
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Gandhoke CS, Syal SK, Singh D, Batra V, Nallacheruvu Y. Cervical C2 to C4 schwannoma with intratumoral hemorrhage presenting as acute spastic quadriparesis: A rare case report. Surg Neurol Int 2018; 9:142. [PMID: 30105136 PMCID: PMC6069368 DOI: 10.4103/sni.sni_171_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/18/2018] [Indexed: 11/04/2022] Open
Abstract
Background Spinal schwannomas are slow growing, benign nerve sheath tumors. These may be asymptomatic or may present as backache with radicular pain, slowly progressive neurological deficits, but rarely with acute spastic quadriparesis attributed to intratumoral hemorrhage. Case Description A 38-year-old male presented with the chief complaint of neck pain radiating to the left upper extremity for the last 8 months. On admission, he exhibited diffuse hyper-reflexia but had no motor or sensory deficit. Magnetic resonance imaging showed a solid-cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord. The same day the patient acutely developed a spastic quadriparesis. Immediately, a partial C2, C3, and C4 laminectomy was performed for tumor excision; within 5 postoperative days, he fully regained neurological function. The final histopathology was consistent with a "schwannoma showing areas of congestion and hemorrhage." Conclusion Spinal schwannomas rarely present with intratumoral hemorrhage and acute spastic quadriparesis. Immediate operative decompression may lead to excellent postoperative neurological recovery.
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Affiliation(s)
- C S Gandhoke
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and G. B. Pant Institute of Postgraduate Medical Education and Research (G.I.P.M.E.R.), New Delhi, India
| | - S K Syal
- Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - D Singh
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and G. B. Pant Institute of Postgraduate Medical Education and Research (G.I.P.M.E.R.), New Delhi, India
| | - V Batra
- Department of Pathology, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and G. B. Pant Institute of Postgraduate Medical Education and Research (G.I.P.M.E.R.), New Delhi, India
| | - Y Nallacheruvu
- Department of Pathology, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and G. B. Pant Institute of Postgraduate Medical Education and Research (G.I.P.M.E.R.), New Delhi, India
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7
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Abstract
Spinal schwannomas are benign intradural extramedullary tumors arising from spinal nerve root sheath. They are usually solid or heterogeneously solid. Totally cystic schwannomas are rare entities. Herein, we report a 60-year-old male presenting with backache radiating along the chest wall and weakness of both lower limbs. He had spastic paraparesis. Magnetic resonance imaging revealed a cystic mass in the thoracic region. At operation, the cystic mass was seen to be attached to D4 dorsal rootlets. It was excised in toto and histopathology confirmed it to be a schwannoma. The relevant literature is reviewed.
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Affiliation(s)
- Sushil Kumar
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Raghavendra Gupta
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Amit Handa
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
| | - Rohan Sinha
- Department of Neurosurgery, St Stephen's Hospital, Tis Hazari, Delhi, India
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8
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Attiah MA, Syre PP, Pierce J, Belyaeva E, Welch WC. Giant cystic sacral schwannoma mimicking tarlov cyst: a case report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26195080 DOI: 10.1007/s00586-015-4128-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a rare case of a giant schwannoma of the sacrum mimicking a Tarlov cyst. METHODS A 58-year-old woman had a 1-year history of low back pain. MRI revealed a large cystic mass in the sacral canal with bony erosion. Radiological diagnosis of Tarlov cyst was made. RESULTS The patient underwent surgical treatment for the lesion, which revealed a solid mass. Histopathological examination of the tumor confirmed the diagnosis of schwannoma. The postoperative course was uneventful and the patient has had significant improvement in her pain 1 month postoperatively. CONCLUSION Giant cystic schwannoma of the sacrum is a very rare diagnosis overlooked by practitioners for more common cystic etiologies, but its treatment is significantly different. Care should be taken to include this diagnosis in a differential for a cystic sacral mass.
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Affiliation(s)
- Mark A Attiah
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
| | - Peter P Syre
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - John Pierce
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | | | - William C Welch
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
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9
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Sahoo RK, Das PB, Sarangi GS, Mohanty S. Acute hemorrhage within intradural extramedullary schwannoma in cervical spine presenting with quadriparesis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:83-5. [PMID: 25972715 PMCID: PMC4426528 DOI: 10.4103/0974-8237.156069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Schwannoma with acute hemorrhage is rarely seen. A 44-years-old male patient presented with complaint of neck pain and acute onset of quadriparesis. Magnetic resonance imaging (MRI) of his cervical spine revealed evidence of an intradural extramedullary tumor with intratumoral acute hemorrhage. He was operated in emergency and the mass was found to be schwannoma with acute hemorrhage. Post operatively the patient improved significantly. Though schwannomas show microscopic intratumoral hemorrhage and necrosis at times, schwannoma with acute hemorrhage resulting acute onset of neurological deficit is very uncommon.
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Affiliation(s)
- Ranjan Kumar Sahoo
- Department of Radiology, Institute of Medical Science and SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India
| | - Pulin Bihari Das
- Department of Orthopedic, Institute of Medical Science and SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India
| | - Gouri Sankar Sarangi
- Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India
| | - Sureswar Mohanty
- Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India
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Corley J, Kasliwal MK, O'Toole JE, Byrne RW. Extensive vertebral scalloping in a case of giant cystic spinal schwannoma: more than just a radiological diagnosis. J Neurooncol 2014; 120:219-20. [PMID: 25017329 DOI: 10.1007/s11060-014-1532-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jackie Corley
- Rush University Medical Center, 1725 W Harrison Street, Suite 855, Chicago, IL, 60612, USA
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12
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Cho DY, Hur JW, Shim JH, Kim JS. Cystic giant sacral schwannoma mimicking aneurysmal bone cyst : a case report and review of literatures. J Korean Neurosurg Soc 2013; 54:350-4. [PMID: 24294462 PMCID: PMC3841281 DOI: 10.3340/jkns.2013.54.4.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/17/2013] [Accepted: 09/30/2013] [Indexed: 12/04/2022] Open
Abstract
To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.
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Affiliation(s)
- Dong-Young Cho
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Giant invasive sacral schwannoma showing chromosomal numerical aberrations [-14,+18,+22]. Asian Spine J 2013; 7:227-31. [PMID: 24066220 PMCID: PMC3779776 DOI: 10.4184/asj.2013.7.3.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/01/2012] [Accepted: 08/04/2012] [Indexed: 11/08/2022] Open
Abstract
Here, we report on a rare case of a giant invasive sacral schwannoma. The patient was a 58-year-old woman who had a 6-year history of non-specific buttock pain. Histological investigation confirmed the diagnosis of cellular schwannoma. The following numerical aberration was detected using the GTG-banding method for karyotypes: 47,XX,-14,+18,+22. Cytogenetic studies of schwannomas have indicated a complete or partial loss of chromosome 22 as the most common abnormality, but this case is cytogenetically rare because of the recurrence of trisomy 22.
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14
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Jadhav CR, Angeline NR, Kumar B, Bhat RV, Balachandran G. Axillary schwannoma with extensive cystic degeneration. J Lab Physicians 2013; 5:60-2. [PMID: 24014973 PMCID: PMC3758710 DOI: 10.4103/0974-2727.115925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Schwannoma affect mainly head, neck, and flexor aspect of the limbs. Neurogenic tumors arising from the brachial plexus are rare and axillary schwannoma is extremely uncommon. Cystic degeneration is common in longstanding cases and which when aspirated may yield only macrophages or lymphocytes leading to false diagnosis of the case in spite of strong clinical suspicion. We report one such rare case of a solitary axillary schwannoma with extensive cystic degeneration, which was misdiagnosed on fine needle aspiration cytology and subsequently confirmed by the histopathological examination and immunohistochemistry.
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Affiliation(s)
- Chaithra R Jadhav
- Indira Gandhi Medical College and Research Center, Puducherry, India ; Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry, India
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16
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Alfieri A, Campello M, Broger M, Vitale M, Schwarz A. Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up. J Neurosurg Spine 2011; 14:167-71. [DOI: 10.3171/2010.10.spine1015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.
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Affiliation(s)
- Alex Alfieri
- 1Neurosurgery, Martin Luther University Hospital Halle-Wittenberg, Germany; and
- 2Department of Neurosurgery, General Regional Hospital, Bolzano/Bozen, Italy
| | - Mauro Campello
- 2Department of Neurosurgery, General Regional Hospital, Bolzano/Bozen, Italy
| | - Maximilian Broger
- 2Department of Neurosurgery, General Regional Hospital, Bolzano/Bozen, Italy
| | - Mario Vitale
- 2Department of Neurosurgery, General Regional Hospital, Bolzano/Bozen, Italy
| | - Andreas Schwarz
- 2Department of Neurosurgery, General Regional Hospital, Bolzano/Bozen, Italy
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Yoshioka S, Sairyo K, Sakai T, Tamura T, Kosaka H, Yasui N. Osseous erosion by herniated nucleus pulposus mimicking intraspinal tumor: a case report. J Orthop Traumatol 2010; 11:257-61. [PMID: 21103903 PMCID: PMC3014474 DOI: 10.1007/s10195-010-0119-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 11/01/2010] [Indexed: 11/30/2022] Open
Abstract
Erosion of spinal osseous structure, so-called scalloping, has been rarely reported associated with herniated nucleus pulposus (HNP). We report a rare case of HNP causing erosion of the spinal osseous structure (including lamina). The patient was an 81-year-old woman with 3-year history of low-back pain and left leg radiating pain. Muscle weakness of the left leg was also apparent. Computed tomography following myelography showed severe compression of the dural sac at the level of L3–L4; furthermore, erosion of the lamina, pedicle, and vertebral body was noted, indicating that the space-occupying mass was most probably a tumorous lesion. The mass also showed calcification inside. During the surgery, the mass was confirmed to be an HNP with calcification. Following resection, the pain disappeared. Surgeons should be aware of the possibility of scalloping of the vertebrae caused by HNP mimicking a tumorous lesion.
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Affiliation(s)
- Shinji Yoshioka
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Giant schwannoma of the cauda equina without neurological deficits -- case report and review of the literature. Wien Klin Wochenschr 2010; 122:645-8. [PMID: 20963637 DOI: 10.1007/s00508-010-1473-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
Abstract
Schwannomas and ependymomas are the most frequent tumours of the filum terminale. Giant schwannomas, however, are very rare in this location with less than 30 cases reported in the literature, most of them presenting with preoperative neurological deficits. We present the case of a giant schwannoma in a 75-year-old lady extending from the level of lower D12 to upper L3 vertebra with low-back pain as the only symptom. Microsurgical removal of the tumour was accomplished via an L1-L2 laminotomy without permanent neurological deficits. Giant schwannoma of the cauda equina is a rare tumour with variable symptoms. Early diagnosis is crucial to obtain good postoperative results. Total removal without additional neurological deficits can be achieved by appropriate microsurgical techniques.
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