Thoracic cystic schwannoma: case report and review of literature

Abstract

Introduction Schwannomas are the second most common type of intra-dural lesions involving the thoracic spine. They are frequently seen as solid and heterogeneous lesions. Totally cystic thoracic schwannomas represent a rare pathological schwannoma variant, with only four cases reported in the English literature to our knowledge. Case presentation We report an 80-year-old male who presented with upper back pain for 3 months. Magnetic resonance imaging (MRI) showed a cystic lesion at the level of T6-T7 with peripheral contrast enhancement. The lesion was removed in total surgically with complete resolution of the patient's symptoms. Discussion The diagnosis of cystic schwannomas is often delayed due to the paucity of symptoms and the lack of meticulous investigation. The presence of rim enhancement on contrast-enhanced MRI may be the only clue for the diagnosis. It is important to consider cystic schwannomas in the differential diagnosis of cystic spinal lesions since the best surgical outcome is strongly related to earlier diagnosis and total resection of the lesion.

Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor

“…Typical MRI features of schwannomas include T1 iso-to hypointensity (compared to the spinal cord), T2 hyperintensity, and post-contrast enhancement ( Crist et al, 2017 ; Samman et al, 2021 ). However, T2 signal patterns can greatly vary from hypointense to hyperintense signal changes depending on the cellularity of the lesion and microstructural abnormalities such as the presence of hemorrhage, necrosis, or cysts ( Ito et al, 2018 ).…”

“…The differential diagnosis of cystic lesions may be more difficult to establish since differences in signal intensities are usually confined to the solid portions of tumors. Ultimately, the differential diagnosis of intraspinal cystic lesions includes hydatid, neurenteric, epidermoid, dermoid, and arachnoid cysts, but those can usually easily be recognized because of distinct imaging features such as a non-enhancing rim ( Samman et al, 2021 ; Netra et al, 2014 ). This was more challenging in our first case where no contrast agent was used (due to the patients’ explicit request) and an arachnoid cyst could not be excluded.…”