Schwannoma of the lumbar spine

Abstract

Objective: To show a case of lumbar spine schwannoma that presented with low back pain and sciatica. Case: A patient that presented with low back pain and sciatica. The Gadoliniumenhanced Magnetic Resonance Imaging (MRI) showed a lumbar L4-L5 schwannoma. He underwent lumbar laminotomy and intradural microsurgery. The lesion was totally removed. There was an important improvement on postoperative and at one-year follow up MRI showed no tumor. Conclusion: The authors stress that spine schwannoma should be considered inthe differential diagnosis of a patient experiencing symptoms of disc herniation, a disease of more common occurrence.

Femoral nerve schwannoma

“…In the present case, the preoperative imaging study permitted the surgeon to consider tumor as the first possibility, despite the fact that in the inguinofemoral area, vascular and inflammatory conditions present themselves as the most frequent pathologies. Peripheral schwannomas are usually benign tumors of the nerve sheath presenting as round or oval mass and, in spite of the length, it is possible to treat them surgically without permanent damage to the nerve 3,4,7 .…”

“…Schwannomas and neurofibromas, as tumors of the nerve sheath, are composed mainly of Schwann cells. A target sign has been described in cases of nerve sheath tumors: this finding consists of a central hypointensity surrounded by a hyperintense rim on T2-weighted and enhanced T1-weighted images and this target sign may be absent when the tumor undergoes necrosis, hemorrhage or cystic change 6,7,8,9 . In cases of schwannomas, tumors adhere to the nerve fibers rather than infiltrate them, whereas in neurofibromas they grow within the nerve, leading to a dissociation of the nerve fibers 6,7 .…”

“…Histological HE and immuno-histochemical evaluation allowed the final diagnosis of a schwannoma: this tumor is composed of tightly packed spindle-shaped cells that sometimes show cellular pleomorphism as a sign of degeneration, as well as cystic components 6,7,8 .…”