17 June 2019 : Case report
Challenging differential diagnosisFumiko Hamabe1ABCDEF, Shigeyoshi Soga1ABCDEF*, Hideaki Imabayashi2BDE, Ayano Matsunaga3BDE, Hiroshi Shinmoto1ADEF
Am J Case Rep 2019; 20:859-863
BACKGROUND: Spinal schwannomas are benign tumors arising from Schwann cells. Although they have been well described, tumor movement in the spinal canal is an extremely rare finding, and entirely cystic spinal schwannomas have rarely been reported. This is the first report of a spinal schwannoma that simultaneously exhibited both these unusual features.
CASE REPORT: A 48-year-old female presented with dysuria and right leg pain. Initial magnetic resonance imaging (MRI) revealed a well-delineated intradural cystic lesion at the level of L4–S1 vertebrae that was isointense with cerebrospinal fluid on both T1- and T2-weighted images. A follow-up MRI 6 months later showed that the tumor had moved to the level of L2–L4; it also revealed tortuous configuration of nerve roots of the cauda equina. The tumor was resected, and a diagnosis of schwannoma with extensive cystic degeneration was pathologically confirmed.
CONCLUSIONS: Various possible mechanisms have been suggested for the mobility of extramedullary tumors. In the present case, MRI findings indicated the cause of the tumor movement might be attributed to the laxity of nerve roots. Besides, it is highly atypical for a schwannoma to present an entirely cystic appearance, and the combination of the 2 extraordinary features made preoperative diagnosis difficult. However, 16 out of 22 (73%) of previously reported mobile spinal tumors were schwannomas, so the differential diagnosis for a mobile spinal tumor should include schwannoma, even when the lesion seems entirely cystic on MRI. To minimize the risk of complications and additional surgical dissection, physicians should acknowledge that spinal tumors can migrate.
Keywords: Cauda Equina, Magnetic Resonance Imaging, Neurilemmoma, Orthopedics, Radiology, Spinal Cord Neoplasms, Lumbar Vertebrae, Middle Aged, Sacrum
13 May 2022 : Case reportAcute Disseminated Encephalomyelitis After SARS-CoV-2 Vaccination
Am J Case Rep In Press; DOI: 10.12659/AJCR.936574
20 April 2022 : Case reportProgressive Worsening of Neurological Manifestations in HIV-Associated Opportunistic Central Nervous System...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936257
16 May 2022 : Case reportPrimary Central Nervous System Burkitt Lymphoma, Presenting with Long-Term Fluctuating Level of Consciousne...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936401
16 May 2022 : Case reportLong-Term Efficacy of Dupilumab in Alopecia Areata
Am J Case Rep In Press; DOI: 10.12659/AJCR.936488
16 May 2022 : Case reportStellate Hypopigmentation in a Pediatric Patient After Treatment with Intralesionally-Injected Corticosteroid
Am J Case Rep In Press; DOI: 10.12659/AJCR.935898
Most Viewed Current Articles
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406