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Shomal Zadeh F, Azhideh A, Mantilla JG, Kosaraju V, Venugopal N, Gaskin CM, Pooyan A, Alipour E, Chalian M. Imaging Features of Intraosseous Schwannoma: A Case Series and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13091610. [PMID: 37175002 PMCID: PMC10178268 DOI: 10.3390/diagnostics13091610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
To characterize the imaging features of patients with pathologically confirmed intraosseous schwannoma (IOS), institutional pathology and imaging databases were searched for IOS cases over a period of 17 years. A musculoskeletal radiologist evaluated all imaging studies. Additionally, a literature search was performed to identify IOS cases that had imaging findings of at least two modalities. Six patients (one female, five males, mean age of 50 ± 14 years) with IOS were identified, with all lesions localized to the lumbosacral region. Radiographic imaging was available in four patients, while all patients underwent CT and MR imaging. Radiographs depicted lytic lesions, and CT depicted heterogeneous expansile lesions with centrally hypodense areas and peripheral sclerosis. All cases involved extra-osseous extension, producing a mass effect on adjacent soft tissues and nerve roots. On MRI, the neoplasms displayed iso- to- slightly- low signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images with heterogeneous enhancement. The literature review resulted in 102 IOS cases, which to the best of our knowledge, is the largest review on IOS, and the imaging findings of the previously published cases were the same as our cases. IOSs are rare benign neoplasms that should be considered in the differential diagnosis of well-defined expansile lytic lesions with sclerotic borders. This is particularly important in middle-aged adults with mandibular, sacral, or vertebral body mass.
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Affiliation(s)
- Firoozeh Shomal Zadeh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
| | - Arash Azhideh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
| | - Jose G Mantilla
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98915, USA
| | - Vijaya Kosaraju
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Nitin Venugopal
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
| | - Cree M Gaskin
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Atefe Pooyan
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
| | - Ehsan Alipour
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98915, USA
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O'Halloran L, O'Halloran A, Murphy S, Morris S. Lumbar spinal intraosseous schwannoma: a non-operative approach. BMJ Case Rep 2022; 15:e249287. [PMID: 36593632 PMCID: PMC9743289 DOI: 10.1136/bcr-2022-249287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Intraosseous schwannomas are benign tumours composed of nerve sheath cells, most commonly affecting the mandible and sacrum. Such intraosseous schwannomas in the vertebra can result in spinal instability causing deformity, pain and even neurological compression. Vertebral involvement in the lumbar spine is extremely rare. A case of a schwannoma of the lumbar spine at the level of L3/L4 is presented. It resulted in progressive lower back pain and right lower limb radiculopathy. The clinical findings, radiological reports and histological diagnosis of this case, along with a review of the literature, are presented. The rationale for non-surgical management of this rare benign tumour is also explored.
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Affiliation(s)
- Louis O'Halloran
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Amanda O'Halloran
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Seamus Morris
- Department of Orthopaedics and Spinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Xu ZQ, Zhang P, Zhong ZH, Zhou W, Yu HT. Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement: A case report. World J Clin Cases 2020; 8:1271-1277. [PMID: 32337202 PMCID: PMC7176626 DOI: 10.12998/wjcc.v8.i7.1271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/13/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal intraosseous schwannomas (SIS) are rare, and as yet have not been fully described in the literature. The first case of SIS was reported in 1971, and 24 cases of SIS have been reported so far. However, including the present case, there are only seven cases without spinal canal and neuroforamina involvement.
CASE SUMMARY A 56-year-old man presented with a history of neck pain for 2 years. An obvious osteolytic destruction of the seventh cervical (C7) vertebra was observed on imaging examination. Magnetic resonance imaging of the cervical spine showed space-occupying lesions in the C7 vertebra, and destruction of the anterior cortex of the vertebra. The lesions had an exophytic component that extended from the C7 vertebra into the soft tissue on the front side. The foramen transversarium on both sides were intact. The patient underwent surgical biopsy and focal excision of the C7 lesion. The diagnosis of “schwannoma” was verified by postoperative pathological examinations. In a review of the literature, this is the seventh case of SIS without spinal canal and neuroforamina involvement, and the third reported case of type VIII SIS. We discussed our case with respect to reported classification characteristics of SIS.
CONCLUSION SIS is a very rare tumor. We report a rare case that may be important for further classification of osteo-schwannoma. The establishment of a complete disease classification is of high importance for the treatment and prognosis of this disease. Thus, more basic studies and retrospective analysis of related cases are necessary.
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Affiliation(s)
- Zhong-Qi Xu
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guanzhou 510000, Guandong Province, China
| | - Ping Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guanzhou 510000, Guandong Province, China
| | - Zhi-Hong Zhong
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guanzhou 510000, Guandong Province, China
| | - Wei Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guanzhou 510000, Guandong Province, China
| | - Hao-Tao Yu
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guanzhou 510000, Guandong Province, China
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Rozman PA, Benjamin CG, Kondziolka D, Sen C, Roland JT, Zagzag D, Snuderl M, Gordon D. Intraosseous Petrous Apex Schwannoma: Case Report and Review of Literature. World Neurosurg 2019; 132:182-187. [PMID: 31476472 DOI: 10.1016/j.wneu.2019.08.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraosseous petrous apex schwannomas are an exceedingly rare entity; little is known about their epidemiology, natural history, and postoperative outcomes. CASE DESCRIPTION Here, we present the fourth known case of a primary intraosseous schwannoma of the petrous apex: a 68-year-old woman presenting with diplopia, facial numbness, progressive intermittent vertigo, tinnitus, diminished hearing, and ataxia. She underwent a transtemporal approach for subtotal resection of the tumor with subsequent stereotactic radiosurgery. CONCLUSIONS Our 2-year follow-up demonstrates slow growth and success of multimodal management in the treatment of these tumors. We review the 3 prior reports of petrous apex schwannomas and identify unifying radiographic and clinical characteristics to aid future diagnostic considerations of lesions of the petrous apex.
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Affiliation(s)
- Peter A Rozman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Chandranath Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - J Thomas Roland
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Otolaryngology, NYU Langone Health, New York, New York, USA
| | - David Zagzag
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - David Gordon
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Liu W, Zhang S, Liu J, Shao Z. Intraosseous Malignant Peripheral Nerve Sheath Tumor of 2 Consecutive Lumbar Vertebrae: A Case Report and Literature Review. World Neurosurg 2019; 130:459-466. [PMID: 31349078 DOI: 10.1016/j.wneu.2019.07.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST), which refers to any malignant tumor that originates from peripheral nerve sheath cells, is rarely found in the spine. Primary intraosseous spinal MPNSTs are extremely uncommon; in fact, such an occurrence has been reported in a very limited number of cases hitherto. We report here one case of low-grade intraosseous MPNST in the lumbar vertebrae and review clinical research related to this rare tumor and modus operandi to its treatment. CASE DESCRIPTION A 51-year-old man suffering from lower back pain was initially diagnosed with lumbar tuberculosis. The intraoperative histopathologic examination, however, revealed that the occupying lesion was synovial sarcoma when surgeons intended to perform a debridement surgery of what was thought to be tuberculosis. The operation was therefore suspended. Two months later, the patient was referred to our institution. The pathologic sections were reexamined. Its results refuted the earlier thought of being synovial sarcoma, and a final diagnosis of MPNST was made. In addition, preoperative examination revealed that the tumor had advanced rapidly to the adjacent inferior vena cava and pedicle, which ruled out the possibility of performing a total en bloc spondylectomy. Therefore, a marginal resection for 2-level consecutive lumbar vertebrae was performed successfully via an anterior-posterior combined approach. No serious complications were detected at 18-month follow-up. CONCLUSIONS Preoperative biopsy is of great importance for the diagnosis of spinal tumors. Marginal resection of a complicated intraosseous spine MPNST via an anterior-posterior combined approach, despite being technically challenging, resulted in good survival and functional outcomes.
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Affiliation(s)
- Weijian Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shuo Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jianxiang Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Intraosseous Thoracic Schwannoma: Case Report and Review of the Literature. World Neurosurg 2019; 130:313-316. [PMID: 31295618 DOI: 10.1016/j.wneu.2019.06.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraosseous locations are extremely rare when it comes to schwannomas and account for 0.2% of primary bone tumors. The most common intraosseous locations include the mandible and sacrum, while cervical, thoracic, and lumbar spine lesions are even more uncommon. CASE DESCRIPTION We describe a 56-year-old female patient with incidental finding of an intraosseous lytic lesion within the vertebral body of T1. Complete surgical excision was performed with instrumented fusion. Histopathology results confirmed a World Health Organization grade I schwannoma. CONCLUSIONS Our case is the fourth case of purely intraosseous schwannoma described in the mobile spine in the literature, with good results both clinically and radiologically after complete surgical resection.
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Tamura R, Takahashi S, Kohno M, Kameyama K, Fujiwara H, Yoshida K. Intraosseous Schwannoma of the Petrous Apex. J Neurol Surg Rep 2015; 76:e135-9. [PMID: 26251791 PMCID: PMC4520976 DOI: 10.1055/s-0035-1549312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/14/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Importance Intraosseous schwannoma is a relatively rare clinical entity that typically arises in vertebral and mandibular bone. Intraosseous schwannoma located entirely within the petrous bone is exceedingly rare, and only two cases have been reported to date. Clinical Presentation A 47-year-old Asian man was referred to our hospital with a chief complaint of double vision. Neurologic examination revealed left abducens nerve palsy. Radiologic imaging showed a 35-mm osteolytic expansive lesion located in the left petrous apex. We made a preoperative diagnosis of chondrosarcoma and performed surgical resection. Surgery was performed via a left subtemporal epidural approach with anterior petrosectomy. The histopathologic diagnosis of the tumor was schwannoma. Schwannoma arising from cranial nerves was excluded from intraoperative findings in conjunction with the results for cranial nerves, and intraosseous schwannoma was diagnosed. Postoperative course was uneventful, and abducens nerve palsy resolved immediately after surgery. Conclusion The differential diagnosis of intraosseous schwannoma should be considered for an osteolytic mass lesion within the petrous apex. Subcapsular tumor removal was considered ideal in terms of preservation of the cranial nerves and vessels around the tumor.
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Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Keio University hospital, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Neurosurgery, Keio University hospital, Shinjuku-ku, Tokyo, Japan
| | - Maya Kohno
- Department of Neurosurgery, Keio University hospital, Shinjuku-ku, Tokyo, Japan
| | - Kaori Kameyama
- Department of Pathology, Keio University hospital, Shinjuku-ku, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Diagnostic Radiology, Keio University hospital, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University hospital, Shinjuku-ku, Tokyo, Japan
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Zhang F, Lu F, Jiang J, Wang H. Two Case Reports and an Updated Review of Spinal Intraosseous Schwannoma. J Korean Neurosurg Soc 2015; 57:478-83. [PMID: 26180620 PMCID: PMC4502249 DOI: 10.3340/jkns.2015.57.6.478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/05/2013] [Accepted: 01/15/2014] [Indexed: 12/12/2022] Open
Abstract
We report two rare cases of spinal intraosseous schwannoma (SIS) with sustained myelopathy symptoms and provide an updated review regarding SIS in the literature. A 71-year-old man experienced right lumbocrural pain and gait disturbance accompanied with paresthesia and right leg weakness. Imaging examinations revealed a mass with lesions in L4 vertebral body causing bone destruction and spinal cord compression. Complete resection of the well-demarcated tumor and posterior fusion were performed. A 54-year-old female reported bilateral gait disturbance, paresthesia, and numbness without weakness, and imaging revealed a posterior mass from T9 causing spinal cord compression and bone erosion. The tumor was completely separated from the spinal nerve root. The tumors from both patients were confirmed as schwannomas. Tumor recurrence was not observed at the 2-4 year follow-up. Although rare, SIS should be considered during differential diagnosis and can affect treatment planning. SIS symptoms vary depending on tumor location, and fusion is frequently necessary for spinal reconstruction after complete tumor resection.
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Affiliation(s)
- Fan Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Feizhou Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
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Mohanty CB, Rao KVLN, Sampath S. Pediatric cervical intraosseous schwannoma. Pediatr Neurosurg 2012; 48:364-70. [PMID: 23969323 DOI: 10.1159/000351734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/02/2013] [Indexed: 12/17/2022]
Abstract
Intraosseous schwannoma of the spine is an extremely rare tumor, with only 18 cases reported so far in the literature. We describe the 1st case of intraosseous schwannoma in the pediatric age group, which was treated successfully, and we review the pertinent literature.
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Affiliation(s)
- Chandan B Mohanty
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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