Mobile thoracic schwannoma combined with intraosseous schwannomas

Abstract

Rationale: Mobile schwannomas have been rarely reported in the lumbar and thoracic spine. These entities are usually intradural extramedullary involving less than 3 vertebrae. Here, we present a rare case of thoracic schwannoma moving over 4 vertebral levels from the primary site combined with intraosseous schwannomas. Patient concerns: A 64-year-old woman presented with back pain for several months. Diagnoses: Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed 2 intraosseous tumors at the T7 and T8 levels and an intradural extramedullary tumor at the T5-6 levels. Interventions: The patient underwent a surgical resection of the intraosseous tumors at the T7 and T8 levels, and the tumor at the T5-6 levels was not found. Postoperative MRI showed that the intradural extramedullary tumor had moved to the T3-4 levels. Subsequently, the patient developed gait disturbance and numbness on bilateral lower limbs. During the second operation, we found the tumor at the T1-2 levels. Eventually, the tumor was completely removed. Outcomes: Histopathological examination showed schwannomas. After a 3-month follow-up, the symptoms were significantly relieved, and there was no clinical or radiological recurrence. Lessons: The clinicians should be aware of the coincidence of intraosseous schwannomas and mobile schwannoma. Careful preoperative MRIs are essential for early diagnosis of mobile tumors. Intraoperative localization of the mobile tumor is imperative to prevent unnecessary laminotomy.

Lumbar spinal intraosseous schwannoma: a non-operative approach

“…Male patients outnumber female patients (male 16, female 11) with patient ages ranging between 22 and 75 years. The majority of cases presented were in patients in their 40s 2–23…”

“…Recurrence is rare but may be associated with incomplete resection 3 25. All reported cases in the literature underwent surgical resection of the tumour,2–23 25 and while the length of follow-up varies, the vast majority of the cases were recurrence free. Only two cases had recurrence and required further surgery 11 15…”

“…This may be applicable to patients with minimal symptoms who have a confirmed histological diagnosis of schwannoma and who are NF2 negative. The vast majority of intraosseous schwannomas in the literature have been treated with surgical resection,2–23 with almost all of these lesions demonstrating benign histology. En bloc surgical intervention in this patient’s case would result in resection of the right L3 nerve root and potentially other elements of the lumbosacral plexus resulting in marked weakness in the right lower limb.…”

Mobile Schwannoma of the Lumbar Spine: A Case Report and literature review

“…Onishi et al,2018 [21] 1 49 M L3 L4/L5 1.5 Caudal Shunjie Jia et al ,2019 [22] 1 64 W T5/T6 T3/T4 2 Rostral…”

Giant Spinal Schwannomas. Presentation of Two Cases with Interdisciplinary Surgical Resection

“…Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient [21] [22] [25] [26]. However, although useful in clinical practice, Toyama's classification system shows its low reliability and reproducibility in the study published by Mengchen et al (2017) [27].…”