Cystic giant sacral schwannoma mimicking aneurysmal bone cyst : a case report and review of literatures

Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis

We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.

An assessment of fluid-fluid levels on magnetic resonance imaging of spinal tumours

OBJECTIVE

To assess the degree of fluid-fluid levels on MRI in spinal tumours compared with final diagnosis, and the outcome of needle biopsy in such cases.

MATERIALS AND METHODS

Retrospective review of patients with a spinal tumour that contained fluid-fluid levels. Data collected included age, sex, spinal location, and final diagnosis. The outcome of needle biopsy was investigated.

RESULTS

Forty-two patients were included (19 males; 24 females; mean age 27.5 years, range 5-80 years), the commonest diagnoses being aneurysmal bone cyst (n = 25; 59.5%) and metastasis (n = 5; 11.9%). All patients with a malignant diagnosis were > 50 years of age apart from 2 who had metastases from a known primary cancer, while all patients apart from 1 with aneurysmal bone cyst were < 35 years of age. Needle biopsy was undertaken in 29 cases (69%) and diagnostic in 18 (62%). Patients with FFL occupying > 2/3 of the lesion were significantly more likely to have an aneurysmal bone cyst (p = 0.008) while those with FFL occupying < 2/3 of the lesion were more likely to have a malignant tumour (p = 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of > 2/3 FFLs occupying the lesion were 97.1%, 75%, 94.3%, 85.7%, and 92.9% respectively for differentiating a benign from a malignant spinal tumour.

CONCLUSIONS

Children and younger adults with spinal lesions containing > 2/3 FFLs were very unlikely to have malignancy. However, in patients > 50 years of age or those with lesions containing < 2/3 FFLs, a malignant lesion is much more likely.

Surgical management of giant presacral schwannoma: systematic review of published cases and meta-analysis

OBJECTIVE

Giant presacral schwannomas are rare sacral tumors found in less than 1 of every 40,000 hospitalizations. Current management of these tumors is based solely upon case reports and small case series. In this paper the authors report the results of a systematic review of the available English literature on presacral schwannoma, focused on identifying the influence of tumor size, tumor morphology, surgical approach, and extent of resection (EOR) on recurrence-free survival and postoperative complications.

METHODS

The medical literature (PubMed and EMBASE) was queried for reports of surgically managed sacral schwannoma, either involving 2 or more contiguous vertebral levels or with a diameter ≥ 5 cm. Tumor size and morphology, surgical approach, EOR, intraoperative and postoperative complications, and survival data were recorded.

RESULTS

Seventy-six articles were included, covering 123 unique patients (mean age 44.1 ± 1.4 years, 50.4% male). The most common presenting symptoms were leg pain (28.7%), lower back pain (21.3%), and constipation (15.7%). Most surgeries used an open anterior-only (40.0%) or posterior-only (30%) approach. Postoperative complications occurred in 25.6% of patients and local recurrence was noted in 5.4%. En bloc resection significantly improved progression-free survival relative to subtotal resection (p = 0.03). No difference existed between en bloc and gross-total resection (GTR; p = 0.25) or among the surgical approaches (p = 0.66). Postoperative complications were more common following anterior versus posterior approaches (p = 0.04). Surgical blood loss was significantly correlated with operative duration and tumor volume on multiple linear regression (both p < 0.001).

CONCLUSIONS

Presacral schwannoma can reasonably be treated with either en bloc or piecemeal GTR. The approach should be dictated by lesion morphology, and recurrence is infrequent. Anterior approaches may increase the risk of postoperative complications.

Giant cystic sacral schwannoma mimicking tarlov cyst: a case report

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.