1
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Le MA, Shi R, Geraghty J, Zayat V, Parikh J. A Rare Case of Hepatic Schwannoma in the Setting of Schwannomatosis. Cureus 2024; 16:e54705. [PMID: 38523988 PMCID: PMC10960616 DOI: 10.7759/cureus.54705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Schwannomas are benign nerve sheath tumors commonly found in the head, neck, vestibular system, and extremities. Primary hepatic schwannomas are exceptionally rare, with 34 cases reported to date according to our review of the literature. This case report describes a 79-year-old man with a medical history of skin and thyroid cancer, who presented with no clinical symptoms and underwent a follow-up MRI due to an initial scan indicating a suspicious hepatic mass resembling an atypical hemangioma. The MRI revealed a 3.6 cm left hepatic mass concerning for an intrahepatic cholangiocarcinoma. Histopathological and immunohistochemical studies of a biopsy of the liver mass confirmed the presence of a benign hepatic schwannoma. Further evaluation revealed multiple spinal schwannomas, leading to the diagnosis of schwannomatosis. The diagnosis of hepatic schwannomas poses challenges through imaging alone. This case underscores the importance of microscopic evaluation in accurately diagnosing hepatic masses. Additionally, the presence of concurrent schwannomas should be considered in patients initially diagnosed with isolated schwannomas.
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Affiliation(s)
- Minh-Anh Le
- Internal Medicine, University of Central Florida College of Medicine/HCA Healthcare Graduate Medical Education, Orlando, USA
| | - Rachel Shi
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Justin Geraghty
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Vania Zayat
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
- Pathology, University of Central Florida College of Medicine, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
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2
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Singh A, Fletcher-Sandersjöö A, El-Hajj VG, Burström G, Edström E, Elmi-Terander A. Long-Term Functional Outcomes Following Surgical Treatment of Spinal Schwannomas: A Population-Based Cohort Study. Cancers (Basel) 2024; 16:519. [PMID: 38339270 PMCID: PMC10854979 DOI: 10.3390/cancers16030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Spinal schwannomas are the second most common form of primary intradural spinal tumor. Despite being benign, they may cause spinal cord compression and subsequently acute or chronic neurological dysfunction. The primary treatment is surgical resection. The aim of this study was to identify pre- and postoperative predictors of favorable outcomes after surgical treatment for spinal schwannoma. All adult patients surgically treated for spinal schwannoma between 2006 and 2020 were eligible for inclusion. Medical records and imaging data were retrospectively reviewed. The primary outcome measures were neurological improvement according to the modified McCormick Scale (mMC) and changes in motor deficit, sensory deficit, gait disturbance, bladder dysfunction, and pain at long-term follow-up. In total, 180 patients with a median follow-up time of 4.4 years were included. Pain was the most common presenting symptom (87%). The median time between symptom presentation and surgery was 12 months, while the median time between diagnosis (first MRI) and surgery was 3 months. Gross total resection (GTR) was achieved in 150 (83%) patients and the nerve root could be preserved in 133 (74%) patients. A postoperative complication occurred in 10 patients (5.6%). There were significant postoperative improvements in terms of motor, sensory, gait, and bladder functions, as well as pain (p < 0.001). Of these symptoms, bladder dysfunction was the one most often improved, with complete symptom resolution in all cases. However, no other predictors of improvement could be identified. There were three cases of recurrence after GTR and nine cases of regrowth after STR. Reoperation was performed in six (3.3%) cases. GTR was associated with a significant improvement in neurological status at long-term follow-up and increased the chance of progression-free survival.
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Affiliation(s)
- Aman Singh
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
- Department of Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
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3
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Chang HS, Sano F, Sorimachi T. Modified Unilateral Approach for Ventrally Located Spinal Tumors. Neurol Med Chir (Tokyo) 2023; 63:443-449. [PMID: 37495522 PMCID: PMC10687673 DOI: 10.2176/jns-nmc.2022-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
Surgery on spinal tumors becomes challenging when the tumor is ventral to the spinal cord. Conventionally, we approach it posteriorly through bilateral laminectomy and rotate the cord after sectioning the dentate ligament and nerve roots. However, manipulating the cord can be hazardous, and a long bilateral laminectomy can be invasive. Meanwhile, a narrow operative field and a limited lateral viewing angle in a unilateral approach constrained the surgeon. To overcome these problems, we previously reported a technique of modified unilateral approach where we incised the skin and the fascia horizontally and placed a pair of retractors longitudinally.The current article reports our experience applying this approach in 15 patients with ventrally located spinal tumors. The approach was performed on 10 schwannomas, 2 meningiomas, and 3 others. We evaluated paraspinal muscle atrophy on postoperative magnetic resonance imaging.The modified unilateral approach provided an excellent surgical field for removing ventrally located tumors. Gross total removal was achieved in 11 patients (92% of benign tumors). No neurological complications occurred except for one case of transient weakness. We encountered no wound-related late complications such as pain or deformity. The reduction of the cross-sectional area of the paraspinal muscles on the approach side (compared to the nonapproach side) was 0.93 (95% confidence interval: 0.72-1.06), indicating 7% atrophy (statistically nonsignificant, p = 0.48).We believe this simple technique can be useful for removing spinal tumors located ventral to the spinal cord.
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Affiliation(s)
| | - Fumiya Sano
- Department of Neurosurgery, Tokai University
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4
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Laliotis N, Chrysanthou C, Baskinis N, Konstandinidis P, Giannakopoulou L, Zarampouka K. Schwannoma of the lumbar spine, presenting with pain of the knee, like an osteoid osteoma, in a 10-year-old girl. Clin Case Rep 2021; 9:224-228. [PMID: 33489164 PMCID: PMC7813033 DOI: 10.1002/ccr3.3503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
Localized pain in the absence of local lesion may represent referred pain from the spine, in a child, arising from a benign spinal schwannoma. It can be diagnosed by MRI. Surgical excision of the tumor relieves the symptoms.
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Affiliation(s)
| | | | - Nikolaos Baskinis
- Neurosurgical DepartmentInterbalkan Medical CenterThessalonikiGreece
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5
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Gao X, Zhang L, Jia Q, Tang L, Guo W, Wang T, Wu Z, Zhou W, Li Z, Xiao J. Whole Genome Sequencing Identifies Key Genes in Spinal Schwannoma. Front Genet 2020; 11:507816. [PMID: 33193598 PMCID: PMC7661748 DOI: 10.3389/fgene.2020.507816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 09/10/2020] [Indexed: 12/16/2022] Open
Abstract
Spinal schwannoma is the most common primary spinal tumor but its genomic landscape and underlying mechanism driving its initiation remain elusive. The aim of the present study was to gain further insights into the molecular mechanisms of this kind of tumor through whole genome sequencing of nine spinal schwannomas and paired blood samples. The results showed that ATM, CHD4, FAT1, KMT2D, MED12, NF2, and SUFU were the most frequently mutated cancer-related genes. In addition, the somatic copy number alterations (CNA) was potentially associated with spinal schwannoma, among which NF2 was found to be frequently deleted in schwannoma samples. Only a few genes were located within the amplified regions. In contrast, the deleted regions in 15q15.1 and 7q36.1 contained most of these genes. With respect to tumorigenesis, NF2 had the highest variant allele frequency (VAF) than other genes, and homozygous deletion was observed in NF1, NF2, and CDKN2C. Pathway-level analysis suggested that Hippo signaling pathway may be a critical pathway controlling the initiation of spinal schwannoma. Collectively, this systematic analysis of DNA sequencing data revealed that some key genes including NF1, NF2, and CDKN2C and Hippo signaling pathway were associated with spinal schwannoma, which may help improve our understanding about the genomic landscape of spinal schwannoma.
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Affiliation(s)
- Xin Gao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Zhang
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science - MOE, School of Statistics, East China Normal University, Shanghai, China.,Center for Bioinformatics and Computational Biology, School of Life Sciences, Institute of Biomedical Sciences, East China Normal University, Shanghai, China
| | - Qi Jia
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Tang
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Guo
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Orthopedics, Taizhou People's Hospital, Taizhou, China
| | - Tao Wang
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zheyu Wu
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wang Zhou
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhenxi Li
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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6
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Khan ESKBM, Thean CAP, Zakaria ZB, Awang MSB, Karupiah RK, Awang MB. A Rare Presentation of Spinal Schwannoma Causing Conus Medullaris Syndrome: A Case Series on Surgical Outcome. J Orthop Case Rep 2020; 10:101-105. [PMID: 32953668 PMCID: PMC7476700 DOI: 10.13107/jocr.2020.v10.i02.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Spinal schwannoma can occur anywhere along the spinal cord but is predominantly seen in the cervical and thoracic region.It composes mainly of well-differentiated schwann cell and is benign in nature. It is typically seen in the peripheral nerves and is commonly associated with neurofibromatosis. Up to 80% of cases, spinal schwannoma is reported to be intradural in location and 15% of cases have both intradural and extradural components. Spinal schwannoma rarely causes conus medullaris syndrome. Case Report In this case series, all three female patients in their 4th and 5th decades of life presented with conus medullaris syndrome. Lower back pain, radiculopathy, lower limb weakness, and urinary incontinence are their main clinical presentation. Magnetic resonance imaging shows a well-defined intradural, extramedullary mass compressing onto the conus medullary region. These patients undergone microscopic assisted excision of the tumor and had remarkably good early outcome despite the advanced presentation of neurological deficit. Conclusion Despite the late presentation with significant neurological deficit, surgical excision of spinal schwannomas carries a good prognosis postoperatively due to their benign nature and extramedullary location.
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Affiliation(s)
- Ed Simor Khan Bin MorJapar Khan
- Department of Orthopaedics, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Charles Ang Poh Thean
- Department of Orthopaedics, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Zamzuri Bin Zakaria
- Department of Orthopaedics, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Bin Awang
- Department of Neurosurgery, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Rajandra Kumar Karupiah
- Department of Orthopaedics, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - MohdShukrimi Bin Awang
- Department of Orthopaedics, International Islamic University Malaysia Medical Centre (IIUM MC), Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
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7
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Tish S, Habboub G, Lang M, Ostrom QT, Kruchko C, Barnholtz-Sloan JS, Recinos PF, Kshettry VR. The epidemiology of spinal schwannoma in the United States between 2006 and 2014. J Neurosurg Spine 2019; 32:1-6. [PMID: 31881538 DOI: 10.3171/2019.10.spine191025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal schwannoma remains the third most common intradural spinal tumor following spinal meningioma and ependymoma. The available literature is generally limited to single-institution reports rather than epidemiological investigations. As of 1/1/2004, registration of all benign central nervous system tumors in the United States became mandatory after the Benign Brain Tumor Cancer Registries Amendment Act took action, which provided massive resources for United States population-based epidemiological studies. This article describes the epidemiology of spinal schwannoma in the United States from January 1, 2006, through December 31, 2014. METHODS In this study, the authors utilized the Central Brain Tumor Registry of the United States, which corresponds to 100% of the American population. The Centers for Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance Epidemiology and End Results program provide the resource for this data registry. The authors included diagnosis years 2006 to 2014. They used the codes per the International Coding of Diseases for Oncology, 3rd Edition: histology code 9560/0 and site codes C72.0 (spinal cord), C70.1 (spinal meninges), and C72.1 (cauda equina). Rates are per 100,000 persons and are age-adjusted to the 2000 United States standard population. The age-adjusted incidence rates and 95% confidence intervals are calculated by age, sex, race, and ethnicity. RESULTS There were 6989 spinal schwannoma cases between the years 2006 and 2014. The yearly incidence eminently increased between 2010 and 2014. Total incidence rate was 0.24 (95% CI 0.23-0.24) per 100,000 persons. The peak adjusted incidence rate was seen in patients who ranged in age from 65 to 74 years. Spinal schwannomas were less common in females than they were in males (incidence rate ratio = 0.85; p < 0.001), and they were less common in blacks than they were in whites (IRR = 0.52; p < 0.001) and American Indians/Alaska Natives (IRR = 0.50; p < 0.001) compared to whites. There was no statistically significant difference in incidence rate between whites and Asian or Pacific Islanders (IRR = 0.92; p = 0.16). CONCLUSIONS The authors' study results demonstrated a steady increase in the incidence of spinal schwannomas between 2010 and 2014. Male sex and the age range 65-74 years were associated with higher incidence rates of spinal schwannomas, whereas black and American Indian/Alaska Native races were associated with lower incidence rates. The present study represents the most thorough assessment of spinal schwannoma epidemiology in the American population.
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Affiliation(s)
- Shahed Tish
- 1Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center and
- 7Department of General Surgery, Washington University, St. Louis, Missouri
| | - Ghaith Habboub
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Min Lang
- 1Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center and
- 6Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Quinn T Ostrom
- 3Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- 4Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Carol Kruchko
- 3Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- 3Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- 5Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pablo F Recinos
- 1Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center and
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center and
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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8
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Perry A, Peters P, Graffeo CS, Carlstrom LP, Krauss WE. Synchronous Presentation of a Cervical Spinal Schwannoma and Primary Progressive Multiple Sclerosis in a 65-year-old Man. Cureus 2019; 11:e4176. [PMID: 31093475 PMCID: PMC6502288 DOI: 10.7759/cureus.4176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Schwannomas are common benign neoplasms of the myelinating cells surrounding peripheral nerve axons. Though uncommon, lesions arising in the cervical spine may produce radicular pain and myelopathic weakness. Multiple sclerosis (MS) is a common autoimmune disorder with the capacity to mimic nearly any neurologic disease, including spinal cord neoplasms. We report the third case of synchronously presenting primary progressive MS and spinal schwannoma. A 65-year-old man presented with six months of progressive weakness and pain of the right shoulder, forearm, and hand. MRI demonstrated a contrast-enhancing transforaminal lesion at C7, most consistent with a benign nerve sheath tumor. Additional history disclosed several years of worsening fatigue, accompanied by bilateral weakness and lancinating leg pain. MRI of the neuraxis demonstrated abnormalities consistent with chronic demyelinating disease intracranially and within the spinal cord; cerebrospinal fluid (CSF) analysis revealed nine oligoclonal bands and an elevated IgG index, resulting in the diagnosis of MS. Given the symptomatic C7 lesion, the patient subsequently underwent right C6-C7 facetectomy, gross total resection of the tumor, and C6-T1 posterior instrumented fusion. Postoperatively, the patient rapidly recovered normal right upper extremity function, and pathology confirmed benign schwannoma. Synchronously presenting co-morbid neurologic diagnoses are exceedingly rare. Nonetheless, the high incidence and protean nature of MS make it particularly susceptible to such confounding clinical cases. Correspondingly, MS should be considered when neurologic abnormalities are not compatible with a focal radiographic lesion, and the present report emphasizes the value of a good history and exam in unraveling similarly challenging cases.
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DE Carvalho RM, DE Castro Sant' Anna C, Pinto GR, Paschoal EHA, Tuji FM, DO Nascimento Borges B, Soares PC, Júnior AGF, Rey JA, Chaves LCL, Burbano RR. Frequency of the Loss of Heterozygosity of the NF2 Gene in Sporadic Spinal Schwannomas. Anticancer Res 2018; 38:2149-2154. [PMID: 29599333 DOI: 10.21873/anticanres.12455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Individuals with type 2 Neurofibromatosis are predisposed for the appearance of schwannomas. In the present study we analyzed the loss of heterozygosity and mutations in the NF2 gene in patients with sporadic Schwannoma without Neurofibromatosis type 2. MATERIALS AND METHODS We analyzed 39 patients with sporadic spinal schwannoma. We quantified the number of alleles by FISH and sequenced the NF2 gene. RESULTS We identified 16/39 patients with point mutations and/or LOHs in the tumor samples analyzed. The LOHs were found in 7/39 patients. Two homozygous mutations were detected in 4/39 tumors, and the presence of the mutation in heterozygosis was revealed in 3/39 patients. In two tumors, we detected the loss of one allele of the NF2 gene, with no mutation. CONCLUSION The genetic alterations observed in the NF2 gene indicated that spinal schwannomas are associated with genetic alterations also found in other schwannomas and type 2 Neurofibromatosis, which reinforces the etiological role of this gene.
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Affiliation(s)
| | - Carla DE Castro Sant' Anna
- Laboratory of Molecular Biology, Ophir Loyola Hospital, Belém, Brazil .,João de Barros Barreto University Hospital, Belém, Brazil
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10
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Porčnik A, Žele T, Prestor B. Concurrent intradural meningioma and schwannoma at the same lumbar level in a patient without neurofibromatosis: a case report. Br J Neurosurg 2017; 34:104-106. [PMID: 29271254 DOI: 10.1080/02688697.2017.1419162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spinal schwannomas coexisting with meningiomas in patient without neurofibromatosis are extremely rare lesions. Here we present a case of 59-year-old patient with concurrent spinal meningioma and schwannoma at L1-L2 spinal level. This is the first case of the concurrent intradural tumours at the same lumbar level.
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Affiliation(s)
- Andrej Porčnik
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tilen Žele
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Prestor
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Abstract
Schwannomas are the most frequent primary tumors of the spine with an incidence of 0.3-0.5/100,000 person per year. Current treatment for non-syndromic spinal schwannomas is total resection of the tumor with preservation of neurovascular structures. This study aims to report neurologic and radiologic outcome following treatment of non-syndromic spinal schwannomas along with a novel tumor classification used in our clinic. A retrospective case series was carried out with a patient sample of 82 male and female patients with non-syndromic spinal schwannomas. All patient data were retrospectively collected from the hospital records. As a routine procedure, after admittance and primary evaluation, patients' tumors were classified using CT or MRI in accordance with our proposed classification method, which employs a dual designation method with tree groups (A, B, and C) for tumor volume and four types (I, II, III, and IV) for tumor localization. Subsequent resection surgery was followed by neurological assessments and follow up at 45th, 180th, and 360th postoperative day. Along with Karnofsky performance status scale, pain, sensory deficits, and motor weakness were scored to assess neurologic recovery. Our finding indicates that patients with different tumor types significantly differ in their neurological scores and show consistent but differential neurological recovery at early and late time points postsurgery. Complications during and postsurgery were minimal, occurring only in two patients. Our findings further reinforce the established safety of total resection operations and indicate that our proposed classification is a simple, effective tool that has proven helpful in preoperative planning and avoiding unnecessary surgical approaches.
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Affiliation(s)
- Ibrahim Sun
- Department of Neurosurgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - M. Necmettin Pamir
- Department of Neurosurgery, Acıbadem University School of Medicine, Istanbul, Turkey
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12
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Hdeib A, Goodwin CR, Sciubba D, Bydon A, Wolinsky JP, Witham T, Gokaslan ZL. Hemorrhagic thoracic schwannoma presenting with intradural hematoma and acute paraplegia after spinal manipulation therapy. Int J Spine Surg 2016; 10:42. [PMID: 28377856 DOI: 10.14444/3042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hemorrhagic conversion of spinal schwannomas represents a rare occurrence; also rare is the development of a spinal intradural hematoma after spinal manipulation therapy. We report a unique presentation of paraplegia in a patient who underwent spinal manipulation therapy and was found to have a hemorrhagic thoracic schwannoma at time of surgery in the setting of anti-platelet therapy use. In patients with spinal schwannomas, tumor hemorrhage is a rare occasion, which can be considered in the setting of additive effects of spinal manipulation therapy and antiplatelet therapy.
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Affiliation(s)
- Alia Hdeib
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD; University Hospitals Case Medical Center, Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - C Rory Goodwin
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Daniel Sciubba
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Ali Bydon
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Jean-Paul Wolinsky
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Timothy Witham
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Ziya L Gokaslan
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD; The Warren Alpert Medical School of Brown University, Department of Neurosurgery, Providence, RI
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13
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Li P, Zhao F, Zhang J, Wang Z, Wang X, Wang B, Yang Z, Yang J, Gao Z, Liu P. Clinical features of spinal schwannomas in 65 patients with schwannomatosis compared with 831 with solitary schwannomas and 102 with neurofibromatosis Type 2: a retrospective study at a single institution. J Neurosurg Spine 2015; 24:145-54. [PMID: 26407091 DOI: 10.3171/2015.3.spine141145] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical features of spinal schwannomas in patients with schwannomatosis and compare them with a large cohort of patients with solitary schwannomas and neurofibromatosis Type 2 (NF2). METHODS The study was a retrospective review of 831 patients with solitary schwannomas, 65 with schwannomatosis, and 102 with NF2. The clinical, radiographic, and pathological data were extracted with specific attention to the age at onset, location of tumors, initial symptoms, family history, and treatment outcome. RESULTS The male-to-female ratio of patients with schwannomatosis (72.3% vs 27.7%) was significantly higher than that of patients with solitary schwannomas (53.3% vs 46.7%) and NF2 (54.0% vs 46.0%), respectively (chi-square test, p = 0.012). The mean age at the first spinal schwannoma operation of patients with NF2 (24.7 ± 10.2 years) was significantly younger than that of patients with solitary schwannomas (44.8 ± 13.2 years) and schwannomatosis (44.4 ± 14.1 years; 1-way ANOVA, p < 0.001). The initial symptoms were similar among the 3 groups, with pain being the most common. The distribution of spinal tumors among the 3 groups was significantly different. The peak locations of spinal schwannomas in patients with solitary schwannomas were at C1-3 and T12-L3; in schwannomatosis, the peak location was at T12-L5. A preferred spinal location was not evident for intradural-extramedullary tumors in NF2. Only a slight prominence in the lumbar area could be observed. The patients in the 3 groups obtained similar benefits from the operation; the recovery rates in the patients with solitary schwannomas, NF2, and schwannomatosis were 50.1%, 38.0%, and 53.9%, respectively. The prognosis varied among spinal schwannomas in the patients with schwannomatosis. Up until the last date of follow-up, most patients with schwannomatosis (81.5%) had undergone a single spinal operation, but 12 patients (18.5%) had undergone multiple spinal operations. Patients with nonsegmental schwannomatosis or those with early onset disease seemed to have a poor prognosis; they were more likely to undergo multiple spinal operations. Small cauda equina nodules were common in patients with schwannomatosis (46.7%) and NF2 (86.9%); these small schwannomas appeared to have relatively static behavior. Two patients suspicious for schwannomatosis were diagnosed with NF2 with the detection of constitutional NF2 mutations; 1 had unilateral vestibular schwannoma, and the other had suspicious bilateral trigeminal schwannomas. CONCLUSIONS The clinical features of spinal schwannomas vary among patients with solitary schwannomas, NF2, and schwannomatosis. Spinal schwannomas of patients with NF2 appear to be more aggressive than those in patients with solitary schwannomas and schwannomatosis. Spinal schwannomas of schwannomatosis predominate in the lumbar area, and most of them can be treated successfully with surgery. The prognosis varies among spinal schwannomas of schwannomatosis; some patients may need multiple operations due to newly developed schwannomas. Sometimes, it is difficult to differentiate schwannomatosis from NF2 based on clinical manifestations. It is prudent to perform close follow-up examinations in patients with undetermined schwannomatosis and their offspring.
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Affiliation(s)
- Peng Li
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Fu Zhao
- Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Jing Zhang
- Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Zhenmin Wang
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Xingchao Wang
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Bo Wang
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Zhijun Yang
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Jun Yang
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Zhixian Gao
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
| | - Pinan Liu
- Departments of Neurosurgery, Beijing Tian Tan Hospital; and
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