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Rodman M, Fang D, Khan M, Wu Q. Kyphoplasty of a C2 Body Intraosseous Schwannoma: A Case Report. Cureus 2025; 17:e82264. [PMID: 40370882 PMCID: PMC12077964 DOI: 10.7759/cureus.82264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2025] [Indexed: 05/16/2025] Open
Abstract
We report a case of a 75-year-old male with an incidental and indeterminate lytic lesion of the C2 vertebral body. After rapid enlargement over 16 months, persistent neck pain, and concern for underlying occult malignancy, the patient underwent lesion biopsy and simultaneous balloon kyphoplasty. Histopathological analysis revealed the surprising diagnosis of intraosseous schwannoma. Spinal Intraosseous Schwannomas (SIS) are rare benign tumors, often mimicking more sinister processes on diagnostic imaging. Fortunately, their histologic appearance is identical to schwannomas found more commonly in the soft tissues, providing diagnostic certainty to otherwise ambiguous radiologic findings. Though rare, intraosseous schwannomas remain an important benign diagnostic consideration for incidental solitary lytic bone lesions. To our knowledge, this is the second published case of kyphoplasty involving an SIS.
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Affiliation(s)
- Michael Rodman
- Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Diana Fang
- Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Majid Khan
- Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Qingqing Wu
- Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
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Zhang J, Xiong G, Zheng W, Sun J. Distinguishing Characteristics of Benign Versus Malignant Intraosseous Schwannomas: A Comparative Study. Orthop Surg 2025; 17:753-761. [PMID: 39676615 PMCID: PMC11872382 DOI: 10.1111/os.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 11/25/2024] [Accepted: 11/25/2024] [Indexed: 12/17/2024] Open
Abstract
OBJECTIVES Benign and malignant intraosseous schwannomas are rare, and primarily documented in case reports. This study aims to elucidate the differences in clinical features and imaging manifestations between these tumors. This will help clinicians identify malignant lesions at an early stage, reliable guide treatment decisions, and accurately predict outcomes. METHODS Eighteen patients who underwent surgery and got pathological examinations in our hospital from 2012 to 2023 were retrospectively reviewed. Among them, 14 cases were found benign with 4 malignant. In the benign group, patients underwent curettage followed by bone grafting, whereas the malignant group was treated with extensive resection or amputation. Patients' demographics and radiographic features, including gender, age at diagnosis, symptom duration, tumor location, tumor margin, and the ratio of sclerotic margins were documented and compared between these tumors. All imaging was reviewed by two fellowship-trained musculoskeletal radiologists, who also quantified the sclerotic margin ratio. The intraclass correlation coefficient was used to determine inter-observer agreement. The Mann-Whitney U test was applied for continuous clinical variables, and the chi-square test or Fisher's exact test for categorical variables. RESULTS In our series, the mean age of these patients was 43.1 ± 14.0 years, six patients were male and 12 were female. Pain was the predominant preoperative symptom. The average duration from symptom onset to initial physician visit was 28.5 ± 25.3 months for benign schwannomas and 8.3 ± 4.3 months for malignant schwannomas (p = 0.012). On plain radiographs, 13 (13/14) of benign schwannomas exhibited well-defined margins of bone destruction, compared to 1 (1/4) of malignant schwannomas (p = 0.019). Furthermore, benign schwannomas had a significantly higher sclerotic margin ratio (75.5%) than malignant ones (16.7%) (p = 0.001). No statistically significant difference was found between the two groups in terms of cortical bone destruction (p = 1.0). On MRI, both tumors demonstrated intermediate to slightly hypointense signal intensity on T1-weighted images and heterogeneous high signal intensities on T2-weighted images. CONCLUSIONS Despite their rarity, benign and malignant intraosseous schwannomas should be considered in the differential diagnosis for patients presenting with painful and radiographically lytic bone lesions, especially in the mandible, sacrum, and vertebrae. The ratio of sclerotic margins, which we proposed for the first time, in combination with symptom duration and the clarity of tumor margins, provide valuable diagnostic clues for distinguishing the malignancy of the tumors.
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Affiliation(s)
- Jiangchao Zhang
- Peking University Fourth School of Clinical MedicineBeijingChina
| | - Ge Xiong
- Peking University Fourth School of Clinical MedicineBeijingChina
- Department of Hand SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Wei Zheng
- Department of Hand SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Jing Sun
- Department of RadiologyBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
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Okamoto D, Ushijima Y, Fujita N, Ishimatsu K, Murayama R, Itoyama M, Ishigami K. Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion. MINIM INVASIV THER 2024; 33:171-175. [PMID: 38315057 DOI: 10.1080/13645706.2024.2311720] [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] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. MATERIAL AND METHODS Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. RESULTS The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. CONCLUSION CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.
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Affiliation(s)
- Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Murayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Itoyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Jia Q, Lou Y, Chen D, Li X, Liu Y, Chu R, Wang T, Zhou Z, Li D, Wan W, Huang Q, Yang X, Wang T, Wu Z, Xiao J. Long-term postoperative outcomes of spinal cellular schwannoma: study of 93 consecutive cases. Spine J 2024; 24:858-866. [PMID: 38272127 DOI: 10.1016/j.spinee.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND CONTEXT Cellular schwannoma (CS) is a rare tumor that accounts for 2.8%-5.2% of all benign schwannomas. There is a dearth of up-to-date information on spinal CS in the literature. PURPOSE The aims of this study were to identify the proportion of CS cases amongst spinal benign schwannoma, describe the clinical features of spinal CS, and identify prognostic factors for local recurrence by analyzing data from 93 consecutive CS cases. STUDY DESIGN Retrospective review. PATIENT SAMPLE We analyzed 93 PSGCT screened from 1,706 patients with spine CS who were treated at our institute between 2008 and 2021. OUTCOME MEASURES Demographic, radiographic, operative and postoperative data were recorded and analyzed. METHODS We compared the clinical features of spinal CS from the cervical, thoracic, lumbar and sacral segments. Prognostic factors for local recurrence-free survival (RFS) were identified by the Kaplan-Meier method. Factors with p≤.05 in univariate analysis were subjected to multivariate analysis by Cox regression analysis. RESULTS The proportion of spinal CS in all benign schwannomas was 6.7%. The mean and median follow-up times for the 93 patients in this study were 92.2 and 91.0 months respectively (range 36-182 months). Local recurrence was detected in 11 cases, giving an overall recurrence rate of 11.7%, with one patient death. Statistical analysis revealed that tumor size ≥5 cm, intralesional resection, and Ki-67 ≥5% were independent negative prognostic factors for RFS in spinal CS. CONCLUSIONS Whenever possible, en bloc resection is recommended for spinal CS. Long-term follow-up should be carried out for patients with tumor size ≥5 cm and postoperative pathological Ki-67 ≥5%.
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Affiliation(s)
- Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yan Lou
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dingbang Chen
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaolin Li
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yiqian Liu
- Department of Medical Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ruitong Chu
- Department of Anesthesiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ting Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhenhua Zhou
- Department of Medical Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dong Li
- Department of General Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Wan
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Quan Huang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tao Wang
- Department of Orthopedics, The second affiliated hospital of Anhui Medical University, No.678 Furong Road, Jingkai district, Hefei, Anhui provice, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China.
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Iwai C, Nozawa S, Fushimi K, Yamada K, Akiyama H. Surgical Management of Intraosseous Neurofibroma in Cervical Spine: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00029. [PMID: 38341863 DOI: 10.2106/jbjs.cc.23.00480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
CASE A 30-year-old man had cervical radiculomyelopathy and neck pain caused by a massive intraosseous neurofibroma (IONF) originating from the C6 vertebrae. We performed posterior tumor resection with spinal instrumentation and fusion from C3 to T2 and a follow-up resection procedure of the remaining C6 anterior tumor, sacrificing the affected vertebral artery (VA), which accordingly required bypass surgery at 2 months recovery. Reconstruction using a titanium mesh cage was successfully performed. There were no local recurrences at 2 years postoperatively. CONCLUSIONS Total tumor resection split into 2 stages with sacrifice of the affected VA is a feasible option for treatment of IONF.
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Affiliation(s)
- Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazunari Fushimi
- Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kazunari Yamada
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Vanegas Cerna G, Barrientos Castillo RE, Nurmukhametov R, Baldoncini M, López Lara CE, Rosario A, Ogando YE, Ramirez KM, Lafuente J, Chmutin GE, Montemurro N, Ramirez MDJE. Giant Invasive Intradural Extramedullary Lumbar Schwannoma: A Case Report and Literature Review. Cureus 2023; 15:e40708. [PMID: 37485228 PMCID: PMC10359865 DOI: 10.7759/cureus.40708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Schwannomas are benign nerve sheath tumors that arise from Schwann cells, which are responsible for producing the myelin sheath that surrounds nerves. They are typically slow-growing and can occur in various locations in the body, including the lumbar region of the spine. We present a case of giant invasive intradural extramedullary schwannoma managed with posterior lumbar interbody fusion (PLIF) and laminectomy with excellent results. A 58-year-old man presented with lower back pain radiating to the right leg for six months. He had no history of trauma or systemic disease. Lumbosacral magnetic resonance imaging (MRI) showed a well-defined mass at the L3-L4 level compressing the right nerve root. The patient was managed with L3-L4-L5 transpedicular fixation and right-side laminectomy L3-L4 for resection of the tumor. Histopathological examination confirmed the diagnosis of schwannoma. The patient had a favorable postoperative recovery and experienced a resolution of symptoms. Lumbar schwannomas are rare they can cause significant symptoms and require appropriate diagnosis and management. Microsurgery is the preferred treatment, and endoscopic microsurgery is the most promising technique.
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Affiliation(s)
| | | | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, ARG
| | | | - Andreina Rosario
- Department of Anatomy, Autonomous University of Santo Domingo (UASD), Santo Domingo, DOM
| | - Yamaurys E Ogando
- Department of Neurological Surgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Karina M Ramirez
- Department of Neurological Surgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Jesus Lafuente
- Department of Neurological Surgery, Hospital Universitario del Mar, Barcelona, ESP
| | - Gennady E Chmutin
- Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, ITA
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Hirai T, Yoshii T, Inose H, Matsukura Y, Funauchi Y, Egawa S, Utagawa K, Hashimoto J, Nishizawa M, Yamamoto K, Okawa A. Intraosseous Aggressive Schwannoma in the Lumbar Spine: A Case Report. Spine Surg Relat Res 2023; 7:288-292. [PMID: 37309502 PMCID: PMC10257963 DOI: 10.22603/ssrr.2022-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/26/2022] [Indexed: 06/14/2023] Open
Affiliation(s)
- Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Matsukura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Funauchi
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kurando Utagawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Nishizawa
- Department of Internal Medicine, Oizumi Cooperative Hospital, Tokyo, Japan
| | - Kohei Yamamoto
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Zhai P, Wu H, Tong L, Wang Y, Sun Z. Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study. J Orthop Surg Res 2023; 18:358. [PMID: 37183257 PMCID: PMC10184340 DOI: 10.1186/s13018-023-03816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas. METHODS This study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated. RESULTS Of these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9-27), which was significantly improved compared to the preoperative median JOA score of 15 (10-22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0-2), which was significantly improved compared to the preoperative median VAS score of 4 (2-8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage. CONCLUSION The inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.
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Affiliation(s)
- Pengfei Zhai
- Department of NeuroSpine Surgery, Tianjin Huanhu Hospital, Tianjin, China.
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
| | - Haiyang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Linjian Tong
- Department of NeuroSpine Surgery, Tianjin Huanhu Hospital, Tianjin, China
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Yulin Wang
- Department of NeuroSpine Surgery, Tianjin Huanhu Hospital, Tianjin, China
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Zhiming Sun
- Department of NeuroSpine Surgery, Tianjin Huanhu Hospital, Tianjin, China.
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
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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: 5] [Impact Index Per Article: 2.5] [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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Cao J, Wang X, Qiao Y, Chen S, Wang P, Sun H, Zhang L, Liu T, Liu S. Differentiation of benign and malignant spinal schwannoma using guided attention inference networks on multi-source MRI: comparison with radiomics method and radiologist-based clinical assessment. Acta Radiol 2023; 64:1184-1193. [PMID: 36039494 DOI: 10.1177/02841851221119375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Differentiating diagnosis between the benign schwannoma and the malignant counterparts merely by neuroimaging is not always clear and remains still confounding in many cases because of atypical imaging presentation encountered in clinic and the lack of specific diagnostic markers. PURPOSE To construct and validate a novel deep learning model based on multi-source magnetic resonance imaging (MRI) in automatically differentiating malignant spinal schwannoma from benign. MATERIAL AND METHODS We retrospectively reviewed MRI imaging data from 119 patients with the initial diagnosis of benign or malignant spinal schwannoma confirmed by postoperative pathology. A novel convolutional neural network (CNN)-based deep learning model named GAIN-CP (Guided Attention Inference Network with Clinical Priors) was constructed. An ablation study for the fivefold cross-validation and cross-source experiments were conducted to validate the novel model. The diagnosis performance among our GAIN-CP model, the conventional radiomics model, and the radiologist-based clinical assessment were compared using the area under the receiver operating characteristic curve (AUC) and balanced accuracy (BAC). RESULTS The AUC score of the proposed GAIN method is 0.83, which outperforms the radiomics method (0.65) and the evaluations from the radiologists (0.67). By incorporating both the image data and the clinical prior features, our GAIN-CP achieves an AUC score of 0.95. The GAIN-CP also achieves the best performance on fivefold cross-validation and cross-source experiments. CONCLUSION The novel GAIN-CP method can successfully classify malignant spinal schwannoma from benign cases using the provided multi-source MR images exhibiting good prospect in clinical diagnosis.
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Affiliation(s)
- Jiashi Cao
- Department of Orthopedics, No. 455 Hospital of Chinese People's Liberation Army, Navy Medical University, Changning District, Shanghai, PR China
- Department of Orthopaedic Oncology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Xiang Wang
- Department of Radiology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Yuanfang Qiao
- Institute for Medical Image Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Minhang District, Shanghai, PR China
| | - Song Chen
- Department of Radiology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Peng Wang
- Department of Radiology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Hongbiao Sun
- Department of Radiology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Lichi Zhang
- Institute for Medical Image Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Minhang District, Shanghai, PR China
| | - Tielong Liu
- Department of Orthopaedic Oncology, 56652Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, PR China
| | - Shiyuan Liu
- Institute for Medical Image Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Minhang District, Shanghai, PR China
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Beute JE, Seo GT, Saturno M, Xing MH, Mundi N, Dowling EM, Matloob A, Chen H, Khorsandi AS, Steinberger J, Urken ML. Central compartment neoplasms masquerading as thyroid tumors: Presentation of two unusual cases and review of the literature. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hesni S, Lindsay D, Saifuddin A. Test Yourself Answer: A 38-year-old male presenting with a 1-year history of medial right knee pain. Skeletal Radiol 2022; 51:1899-1900. [PMID: 35059788 DOI: 10.1007/s00256-022-03998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, HA7 4LP, UK
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13
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Ishikawa T, Akutsu H, Hara T, Tanaka S, Masumoto T, Ishikawa E. Intraosseous schwannoma in the clivus mimicking chordoma treated with endoscopic endonasal surgery: A case report. Surg Neurol Int 2022; 13:346. [PMID: 36128097 PMCID: PMC9479550 DOI: 10.25259/sni_473_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Intraosseous schwannomas are extremely rare and they have not yet been reported to occur in the clivus. We report a schwannoma in the clivus mimicking chordoma and review intraosseous schwannomas of the skull.
Case Description:
A 62-year-old man presented with gradually worsening hoarseness with dysphagia and atrophy of the left tongue, trapezius muscle, and sternocleidomastoid muscle. Magnetic resonance imaging showed that the tumor was mainly located in the clivus, and a computed tomography (CT) scan revealed an osteolytic lesion with expansion of the clivus and preservation of the bony cortex. Endoscopic endonasal surgery was performed to diagnose and treat symptoms. The tumor was subtotally removed without any complications. The histopathological findings revealed typical schwannoma, which showed Antoni A and Antoni B patterns positive for S100 protein. Based on the preoperative imaging, intraoperative and histopathological findings, the tumor was considered to be an intraosseous schwannoma in the clivus, and no recurrence was observed after 1 year of postoperative follow-up.
Conclusion:
Even though the intraosseous schwannoma in the clivus is uncommon, it should be considered as a differential diagnosis if an expansive lesion without destruction of the cortical bone is shown on CT as well as iso-hyperintensity on T2-weighted magnetic resonance imaging.
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Affiliation(s)
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Dokkyo Medical University, Shimotsuga,
| | - Takuma Hara
- Department of Neurosurgery, University of Tsukuba, Tsukuba,
| | - Shuho Tanaka
- Department of Otolaryngology, University of Tsukuba, Tsukuba,
| | - Tomohiko Masumoto
- Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan
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14
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Liu H, Jiao M, Yuan Y, Ouyang H, Liu J, Li Y, Wang C, Lang N, Qian Y, Jiang L, Yuan H, Wang X. Benign and malignant diagnosis of spinal tumors based on deep learning and weighted fusion framework on MRI. Insights Imaging 2022; 13:87. [PMID: 35536493 PMCID: PMC9091071 DOI: 10.1186/s13244-022-01227-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The application of deep learning has allowed significant progress in medical imaging. However, few studies have focused on the diagnosis of benign and malignant spinal tumors using medical imaging and age information at the patient level. This study proposes a multi-model weighted fusion framework (WFF) for benign and malignant diagnosis of spinal tumors based on magnetic resonance imaging (MRI) images and age information. METHODS The proposed WFF included a tumor detection model, sequence classification model, and age information statistic module based on sagittal MRI sequences obtained from 585 patients with spinal tumors (270 benign, 315 malignant) between January 2006 and December 2019 from the cooperative hospital. The experimental results of the WFF were compared with those of one radiologist (D1) and two spine surgeons (D2 and D3). RESULTS In the case of reference age information, the accuracy (ACC) (0.821) of WFF was higher than three doctors' ACC (D1: 0.686; D2: 0.736; D3: 0.636). Without age information, the ACC (0.800) of the WFF was also higher than that of the three doctors (D1: 0.750; D2: 0.664; D3:0.614). CONCLUSIONS The proposed WFF is effective in the diagnosis of benign and malignant spinal tumors with complex histological types on MRI.
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Affiliation(s)
- Hong Liu
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China.
| | - Menglei Jiao
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100086, China
| | - Yuan Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Jianfang Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yuan Li
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Chunjie Wang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yueliang Qian
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Xiangdong Wang
- Beijing Key Laboratory of Mobile Computing and Pervasive Device, Institute of Computing Technology, Chinese Academy of Sciences, No. 6 Kexueyuan South Road, Haidian District, Beijing, 100190, China.
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15
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Clinical Effect of Laminectomy with Lateral Mass Screw Fixation in Treating Cervical Schwannoma: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8512374. [PMID: 35528181 PMCID: PMC9076331 DOI: 10.1155/2022/8512374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022]
Abstract
Background The objective of this study was to evaluate the clinical effectiveness and safety of laminectomy combined with lateral mass screw fixation in treating cervical intradural extramedullary schwannoma. Methods We retrospectively collected and analyzed medical records of 38 patients who underwent resection of cervical intraspinal schwannoma between January 2012 and April 2019. Based on different surgical procedures, two groups were divided among all participants: laminectomy-only (n = 21) and laminectomy with instrumented fixation (n = 17); the minimum follow-up time was 1 year. The visual analogue scale (VAS) score and neck disability index (NDI) were utilized for pain assessment; the Japanese Orthopedic Association (JOA) score was carried out for the assessment of neurological impairment. Radiographic changes of Cobb angle were compared before and after the surgery. Results Consequently, demographics were well matched in both groups, without any statistical difference (P > 0.05). Compared with preoperation, both surgical procedures significantly improved VAS, NDI, and JOA scores (P < 0.001), but no differences between them (P > 0.05). In terms of postoperative spinal instability/deformity, laminectomy-only caused more events than instrumented fixation, which is statistically significant (P < 0.001). Conclusions In summary, laminectomy with lateral mass screw fixation is an effective and safe approach to treat cervical intraspinal schwannoma, which is likely to be a better choice than the laminectomy-only approach.
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16
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Primary Paraganglioma of the Spine: A Systematic Review of Clinical Features and Surgical Management in Cauda Equina vs Non-Cauda Equina Lesions. World Neurosurg 2022; 161:190-197.e20. [PMID: 35123022 DOI: 10.1016/j.wneu.2022.01.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary spine paragangliomas are rare tumors. Surgical resection plays a role, but aggressive lesions are challenging. We reviewed the literature on primary spine paragangliomas. METHODS PubMed, Scopus, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies on primary spine paragangliomas. Clinical-radiological features, treatments, and outcomes were analyzed and compared between cauda-equina vs non-cauda-equina tumors. RESULTS We included 143 studies comprising 334 patients. Median age was 46 years (range, 6-85). The most frequent symptoms were lower-back (64.1%) and radicular (53.9%) pain, and sympathetic in 18 patients (5.4%). Cauda-equina paragangliomas (84.1%) had frequently lumbar (49.1%) or lumbosacral (29%) locations. Non-cauda-equina tumors were mostly in the thoracic (11.4%), thoracolumbar (5.1%), and cervical (3.6%) spine. Median tumor diameter was 2.5cm (range, 0.5-13.0). Surgical resection (98.5%) was preferred over biopsy (1.5%). Decompressive laminectomy (53%) and spine fusion (6.9%) were also performed. Adjuvant radiotherapy was delivered in 39 patients (11.7%) with aggressive tumors. Post-treatment symptomatic improvement was described in 86.2% cases. Median follow-up was 19.5 months (range, 0.1-468.0), and 23 patients (3.9%) had tumor recurrences. No significant differences were found between cauda-equina vs non-cauda-equina tumors. CONCLUSION Surgical resection is effective and safe in treating primary spine paragangliomas; however, adjuvant treatments may be needed for aggressive lesions.
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17
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Michalopoulos GD, Yolcu YU, Ghaith AK, Alvi MA, Carr CM, Bydon M. Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis. J Neurointerv Surg 2021; 13:841-847. [PMID: 33883210 DOI: 10.1136/neurintsurg-2021-017419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes. METHODS A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included. RESULTS Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered. CONCLUSION In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.
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Affiliation(s)
- Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA .,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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18
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Nagashima Y, Nishimura Y, Eguchi K, Awaya T, Yoshikawa S, Haimoto S, Wakabayashi T, Hara M. Intraosseous Melanotic Schwannoma in the Sacrum Mimicking Primary Bone Tumor. NMC Case Rep J 2020; 7:107-111. [PMID: 32695557 PMCID: PMC7363646 DOI: 10.2176/nmccrj.cr.2019-0238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
Primary tumors of sacrum are rarely seen, and the differential diagnosis is extensive, such as chordomas, giant cell tumors, and schwannomas. Sacral intraosseous schwannomas (IOSs) are very rare and encompass approximately 1%–5% of all spinal schwannomas. Melanotic schwannomas (MSs) are categorized as an unusual variant of benign schwannomas; however, they sometimes follow a malignant course. The authors present a case of MS with intraosseous extension into sacrum in a 48-year-old male arising from the left S2 nerve root. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated a destructive mass in the sacrum. He was made a diagnosis with MS by 18F-fluoro-deoxy-glucose positron-emission-tomography (18F-FDG PET) and open biopsy. The tumor was blackish-colored and vascular-rich fragile tumor covered by fibrous capsule. The floor of the tumor was not encapsulated and invading into the sacral bone. Total removal of the tumor together with the left S2 nerve of origin via posterior approach was achieved. The patient made dramatic recovery of neurological symptoms and tumor recurrence is not seen for 6-month follow-up period. MS is a benign tumor with potential for aggressive behavior and capacity to metastasize. Therefore, total removal of the tumor and careful postoperative follow-up are recommended. Postoperative spinopelvic stability also needs to be taken into consideration. The authors discuss our successful management with a focus on diagnostic process, surgical planning, and histological consideration to provide the most up-to-date guidance on managing this challenging tumor.
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Affiliation(s)
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Kaoru Eguchi
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Takayuki Awaya
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | | | - Shoichi Haimoto
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi Japan
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19
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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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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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