Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement: A case report

Ancient schwannoma of the thoracic spine treated with vertebroplasty: A case report

INTRODUCTION

Intraosseous schwannomas or neurilemomas are rare benign neoplasms. Total resection of the intraosseous schwannoma is considered risky in immunocompromised patients, thus minimally invasive vertebroplasty was conducted in this study.

CASE REPORT

In this case, we presented A 40-year-old male presented with intermittent back pain for the last two years. Imaging and histopathological examination conclude the diagnosis of intraosseous schwannoma. Vertebroplasty was conducted without the resection of the tumor. Excellent pain improvement and functional outcome were reported on one-year follow-up.

CLINICAL DISCUSSION

Minimally invasive surgery could decrease post-operative pain and morbidity such as atelectasis and venous thrombosis, earlier hospital discharge, and improved cosmetics. We considered the use of minimally invasive vertebroplasty due to HIV infection comorbidities in the subject. Extensive tumor resection in this population could increase the risks of infection significantly thus affecting the outcome of the surgery. The aim of percutaneous vertebroplasty is to increase the stability of the collapsed vertebra and improve the symptoms, especially with severe back pain.

CONCLUSION

Intraosseous schwannoma of the vertebrae could be treated effectively with vertebroplasty with excellent pain improvement and functional outcome.

Imaging Features of Intraosseous Schwannoma: A Case Series and Review of the Literature

To characterize the imaging features of patients with pathologically confirmed intraosseous schwannoma (IOS), institutional pathology and imaging databases were searched for IOS cases over a period of 17 years. A musculoskeletal radiologist evaluated all imaging studies. Additionally, a literature search was performed to identify IOS cases that had imaging findings of at least two modalities. Six patients (one female, five males, mean age of 50 ± 14 years) with IOS were identified, with all lesions localized to the lumbosacral region. Radiographic imaging was available in four patients, while all patients underwent CT and MR imaging. Radiographs depicted lytic lesions, and CT depicted heterogeneous expansile lesions with centrally hypodense areas and peripheral sclerosis. All cases involved extra-osseous extension, producing a mass effect on adjacent soft tissues and nerve roots. On MRI, the neoplasms displayed iso- to- slightly- low signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images with heterogeneous enhancement. The literature review resulted in 102 IOS cases, which to the best of our knowledge, is the largest review on IOS, and the imaging findings of the previously published cases were the same as our cases. IOSs are rare benign neoplasms that should be considered in the differential diagnosis of well-defined expansile lytic lesions with sclerotic borders. This is particularly important in middle-aged adults with mandibular, sacral, or vertebral body mass.

Lumbar spinal intraosseous schwannoma: a non-operative approach

Intraosseous schwannomas are benign tumours composed of nerve sheath cells, most commonly affecting the mandible and sacrum. Such intraosseous schwannomas in the vertebra can result in spinal instability causing deformity, pain and even neurological compression. Vertebral involvement in the lumbar spine is extremely rare. A case of a schwannoma of the lumbar spine at the level of L3/L4 is presented. It resulted in progressive lower back pain and right lower limb radiculopathy. The clinical findings, radiological reports and histological diagnosis of this case, along with a review of the literature, are presented. The rationale for non-surgical management of this rare benign tumour is also explored.