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Incidentally diagnosed giant invasive sacral schwannoma

Its clinical features and surgical management without stability

Guray Togral, Murat Arikan, Askin E. Hasturk and Safak Gungor
Neurosciences Journal July 2014, 19 (3) 224-228;

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Preoperative images showing: A) Patient x-ray showing a sclerotic margined, smooth contoured cavity lesion invading the left half of the sacrum. B) Axial CT showing lobulated contoured hypo dense heterogeneous mass that has destructed the neural foramens, filling the pelvis and displacing the bladder anteriorly. C) Coronal CT cross section showing a hyperdense sclerotic lobulated contoured mass, from the left half of the sacrum and filling the pelvis.

  • Figure 2
    Figure 2

    Preoperative MRI sections showing: A) T2 weighted coronal MRI showing hyperintense lobulated mass filling the pelvis. B) T2 weighted axial MRI showing hyperintense mass with its largest diameter 138 × 91 mm. C) T2 weighted sagittal MRI showing a dense heterogeneous opaque mass with agent uptake, sagittal 146 × 114 mm sized mass invading the left sacral spinal canal. D) T1 weighted sagittal MRI showing opaque involvement belonging to calcified and necrotic areas inside the lesion.

  • Figure 3
    Figure 3

    Histopathological examination of specimens: A) Irregular fascicles of spindle cells, nuclear palisading, Hematoxylin & Eosin (HE) × 100. B) Cellular detail. Oval blunt-ended or elongated nuclei, HE × 400. C) Hyalinized blood vessels and relatively myxoid stroma, HE × 200. D) Diffuse S100 protein positivity, HE × 400.

  • Figure 4
    Figure 4

    There was no recurrence detected on MRI in the postoperative first year. A) Axial CT, B) Axial MRI, C) Sagittal MRI. A - anterior, P - posterior, H - head, F - foot

Tables

  • Table 1

    Modified Sridhar classification of benign nerve sheath tumors.5

    Original types
    Type IIntraspinal tumor <2 vertebral segments in length; a: intradural; b: extradural
    Type IIIntraspinal tumor >2 vertebral segments in length (giant tumor)
    Type IIIIntraspinal tumor with extension into nerve root foramen
    Type IVIntraspinal tumor with extraspinal extension (dumbbell tumors); a: extraspinal component <2.5 cm; b: extraspinal component >2.5 cm (giant tumor)
    Type VTumor with erosion into vertebral bodies (giant invasive tumor), lateral and posterior extensions into myofascial planes
    Additional types for spinal intraosseous schwannoma
    Type VITumor in entirely intravertebral location without intraspinal portion
    Type VIIIntraspinal tumor with erosion into vertebral bodies (invasive tumor) and extension into nerve root foramen
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