Cystic Giant Sacral Schwannoma Mimicking Aneurysmal Bone Cyst : A Case Report and Review of Literatures

Abstract

To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.

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

“…Other main differential diagnoses, characterised by compatible imaging, included aneurysmal bone cyst (although no evident, clear-cut typical fluid–fluid levels could be visualised) and infections such as spinal tuberculosis or abscess (although no clinical signs of bacterial infection were present). 3 4 Histopathology supported the final unexpected diagnosis of fully cystic spinal schwannoma.…”

“…Aneurysmal bone cyst is a benign, highly vascular, multiloculated, locally aggressive osteolytic lesion involving most commonly the lumbar and sacral spine in children and adolescents. 3 9 In an aneurysmal bone cyst, the cyst’s content shows variable signal, with a surrounding rim of low T1-WI and T2-WI signal, and the septa enhance on contrast administration. 9 Fluid–fluid levels are characteristic, but not exclusively observed in aneurysmal bone cyst, and may be absent in a proportion of cases.…”

“… 9 Fluid–fluid levels are characteristic, but not exclusively observed in aneurysmal bone cyst, and may be absent in a proportion of cases. 3 …”

Giant cystic sacral schwannoma mimicking tarlov cyst: a case report

“…Most schwannomas are solid or heterogenous tumors, occasionally exhibiting hemorrhagic, calcific, or fibrotic degenerative changes. Cystic changes, however, are exceedingly rare, with only a few cases being reported in the literature [4][5][6]. We present a 58-year-old woman with cystic giant sacral schwannoma, mimicking an atypical Tarlov cyst.…”