Presentation
Lower backache with pain and tingling numbness in both lower limbs for 3 years.
Patient Data
A well-defined irregular intraspinal lesion is noted in the lower spinal canal in the intradural extramedullary location at L4 to S2 levels. The lesion is causing widening of the spinal canal and scalloping of the posterior aspects of the L5, S1, and S2 vertebral bodies with extension into bilateral L5-S1 and S1-S2 neural foramina. The lesion appears mildly hyper-intense on T1 images, suggesting internal hemorrhagic contents, and hyper-intense on T2 images, showing few internal septations and fluid levels. On GRE images, blooming is noted along the peripheral aspect of the lesion and in the dependent fluid, suggesting hemorrhagic content. There is no evidence of restricted diffusion. On post-contrast images, the lesion shows an enhancing posterior mural nodule and a thin rim of peripheral enhancement.
Imaging findings are suggestive of a possible hemorrhagic cystic schwannoma versus myxopapillary ependymoma.
Case Discussion
Histopathology: Schwannoma, CNS WHO Grade 1.
Schwannomas are benign tumors arising from the myelinated nerve sheath, and about 1–5% of schwannomas arise in the spine in the lumbosacral region. These tumors are generally solid, and degenerative changes such as cystic degeneration, hemorrhage, or xanthomatous change can occur. Cystic degeneration usually occurs only in some parts of the tumor, and complete cystic change with only thin peripheral wall enhancement is rare. Only a few such cases have been reported.
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