A rare chronic presentation of schwannoma with hemorrhage

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.

Schwannoma as Extraspinal Swelling Over the Thoracolumbar Region: A Tumor at a Rare Site

“…Manipulation of the tumor may occasionally induce par aesthesia or 'shocks' in the innervated area [ 5 ]. Notably, schwannomas presenting as extraspinal swellings over the thoracolumbar region are exceedingly rare, adding a unique dimension to their clinical manifestation [ 9 ].…”

Hemorrhagic Schwannoma of the Cauda Equina: Case Report and Review of the Literature

“…These hemorrhagic lesions affect almost equally the cervical spine (24%), 4 , 5 , 8 , 11 , 18 , 25 , 27) the lumbar tract (24%), 7 , 13 , 16 , 17 , 21 , 22 , 28) the thoracic tract (20%), 2 , 6 , 9 , 14 , 19 , 29) and the thoraco-lumbar passage (20%) 10 , 12 , 20 , 22 , 24 , 26) while the thoraco-cervical, 15) the sacral-lumbar tract, 30) and the sacral spine 23) are more rarely involved (12%). Bleeding can occur within the tumor (34%), 6 , 11 , 12 , 17 , 22 , 25 , 26 , 27 , 28 , 30) between the inner layer of the dura mater and the arachnoid mater of the meninges (subdural hematoma: 22%) 4 , 5 , 8 , 9 , 16 , 18 , 19) or into the subarachnoid space (subarachnoid hemorrhage: 16%) 7 , 10 , 20 , 21 , 24) ; multiple sites can also be involved (13%), such as intratumoral bleeding with subdural hematoma 2 , 23 , 29) or subarachnoid hemorrhage. 13) …”

Ancient Schwannoma as an exceptional thoracic spinal tumor: A case report

“…Schwannomas, also called neurilemmoma are benign tumors which originate from embryonic neural crest cells of the nerve sheath. It has been reported that these tumors usually occur in the fourth to fifth decades with a slightly female preponderance [ 1 ]. Schwannomas can emerge anywhere along the neural network, however, the head, the flexor surfaces of extremities, and the trunk are mainly involved.…”