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Cystic Giant Sacral Schwannoma Mimicking Aneurysmal Bone Cyst : A Case Report and Review of Literatures

  • Cho, Dong-Young (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hur, Jung-Woo (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Shim, Jung-Hyun (Department of Neurosurgery, Anyang Wiltse Memorial Hospital) ;
  • Kim, Jin-Sung (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2013.07.23
  • Accepted : 2013.09.30
  • Published : 2013.10.28

Abstract

To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.

Keywords

References

  1. Abernathey CD, Onofrio BM, Scheithauer B, Pairolero PC, Shives TC : Surgical management of giant sacral schwannomas. J Neurosurg 65 : 286-295, 1986 https://doi.org/10.3171/jns.1986.65.3.0286
  2. Albert AF, Kirkman MA, du Plessis D, Sacho R, Cowie R, Tzerakis NG : Giant solitary cystic schwannoma of the cervical spine : a case report. Clin Neurol Neurosurg 114 : 396-398, 2012 https://doi.org/10.1016/j.clineuro.2011.10.039
  3. Bhatia S, Khosla A, Dhir R, Bhatia R, Banerji AK : Giant lumbosacral nerve sheath tumors. Surg Neurol 37 : 118-122, 1992 https://doi.org/10.1016/0090-3019(92)90187-R
  4. Cagli S, Isik HS, Yildirim U, Akinturk N, Zileli M : Giant sacral schwannomas. J Neurooncol 110 : 105-110, 2012 https://doi.org/10.1007/s11060-012-0941-1
  5. Chandhanayingyong C, Asavamongkolkul A, Lektrakul N, Muangsomboon S : The management of sacral schwannoma : report of four cases and review of literature. Sarcoma 2008 : 845132, 2008
  6. Choudry Q, Younis F, Smith RB : Intraosseous schwannoma of D12 thoracic vertebra : diagnosis and surgical management with 5-year follow-up. Eur Spine J 16 Suppl 3 : 283-286, 2007
  7. Cury J, Coelho RF, Srougi M : Retroperitoneal schwannoma : case series and literature review. Clinics (Sao Paulo) 62 : 359-362, 2007 https://doi.org/10.1590/S1807-59322007000300024
  8. Friedman DP, Tartaglino LM, Flanders AE : Intradural schwannomas of the spine : MR findings with emphasis on contrast-enhancement characteristics. AJR Am J Roentgenol 158 : 1347-1350, 1992 https://doi.org/10.2214/ajr.158.6.1590138
  9. Hanakita J, Suwa H, Nagayasu S, Nishi S, Iihara K, Sakaida H : Clinical features of intradural neurinomas in the cauda equina and around the conus medullaris. Neurochirurgia (Stuttg) 35 : 145-149, 1992
  10. Hayashi Y, Watanabe T, Kita D, Hayashi Y, Takahira M, Hamada J : Orbital cystic schwannoma originating from the frontal nerve. Case Rep Ophthalmol Med 2012 : 604574, 2012
  11. Hung CH, Tsai TH, Lieu AS, Lin CL, Lee KS, Hwang SL, et al. : Giant invasive schwannoma of cauda equina with minimal neurologic deficit : a case report and literature review. Kaohsiung J Med Sci 24 : 212-217, 2008 https://doi.org/10.1016/S1607-551X(08)70120-7
  12. Inokuchi T, Takiuchi H, Moriwaki Y, Ka T, Takahashi S, Tsutsumi Z, et al. : Retroperitoneal ancient schwannoma presenting as an adrenal incidentaloma : CT and MR findings. Magn Reson Imaging 24 : 1389-1393, 2006 https://doi.org/10.1016/j.mri.2006.07.015
  13. Jaiswal A, Shetty AP, Rajasekaran S : Giant cystic intradural schwannoma in the lumbosacral region : a case report. J Orthop Surg (Hong Kong) 16 : 102-106, 2008 https://doi.org/10.1177/230949900801600124
  14. Kagaya H, Abe E, Sato K, Shimada Y, Kimura A : Giant cauda equina schwannoma. A case report. Spine (Phila Pa 1976) 25 : 268-272, 2000 https://doi.org/10.1097/00007632-200001150-00021
  15. Kececi Y, Gurler T, Gundogan H, Bilkay U, Cagdas A : Benign giant schwannoma located in the upper arm. Ann Plast Surg 39 : 100-102, 1997 https://doi.org/10.1097/00000637-199707000-00019
  16. Klimo P, Jr., Rao G, Schmidt RH, Schmidt MH : Nerve sheath tumors involving the sacrum. Case report and classification scheme. Neurosurg Focus 15 : E12, 2003
  17. Kobayashi S, Uchida K, Kokubo Y, Yayama T, Nakajima H, Inukai T, et al. : A schwannoma of the S1 dural sleeve was resected while the intact nerve fibers were preserved using a microscope. Report of a case with early MRI findings. Minim Invasive Neurosurg 50 : 120-123, 2007 https://doi.org/10.1055/s-2007-982506
  18. Lam DS, Ng JS, To KF, Abdulah V, Liew CT, Tso MO : Cystic schwannoma of the orbit. Eye (Lond) 11 (Pt 6) : 798-800, 1997 https://doi.org/10.1038/eye.1997.208
  19. Lesoin F, Krivosic I, Cama A, Jomin M : A giant intrasacral schwannoma revealed by lumbosacral pain. Neurochirurgia (Stuttg) 27 : 23-24, 1984
  20. Liu YW, Chiu HH, Huang CC, Tu CA : Retroperitoneal schwannoma mimicking a psoas abscess. Clin Gastroenterol Hepatol 5 : A32, 2007
  21. Ogose A, Hotta T, Sato S, Takano R, Higuchi T : Presacral schwannoma with purely cystic form. Spine (Phila Pa 1976) 26 : 1817-1819, 2001 https://doi.org/10.1097/00007632-200108150-00020
  22. Ortolan EG, Sola CA, Gruenberg MF, Carballo Vazquez F : Giant sacral schwannoma. A case report. Spine (Phila Pa 1976) 21 : 522-526, 1996 https://doi.org/10.1097/00007632-199602150-00023
  23. Parmar H, Patkar D, Gadani S, Shah J : Cystic lumbar nerve sheath tumours : MRI features in five patients. Australas Radiol 45 : 123-127, 2001 https://doi.org/10.1046/j.1440-1673.2001.00891.x
  24. Parmar HA, Ibrahim M, Castillo M, Mukherji SK : Pictorial essay : diverse imaging features of spinal schwannomas. J Comput Assist Tomogr 31 : 329-334, 2007 https://doi.org/10.1097/01.rct.0000243449.48857.ec
  25. Pushker N, Meel R, Sharma S, Bajaj MS, Kashyap S, Sen S : Giant orbital schwannoma with fluid-fluid levels. Br J Ophthalmol 95 : 1168, 1180-1161, 2011
  26. Saito T, Shimode M, Azuma S, Seichi A : Giant schwannoma of the cauda equina with dural ectasia : a case report. J Orthop Sci 9 : 635-637, 2004 https://doi.org/10.1007/s00776-004-0819-y
  27. Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B : Giant invasive spinal schwannomas : definition and surgical management. J Neurosurg 94 : 210-215, 2001
  28. Vikram M, Pande A, Vasudevan MC, Ravi R : Cervical solitary long segment cystic Schwannoma. Br J Neurosurg 24 : 208-210, 2010 https://doi.org/10.3109/02688690903301557
  29. Wilkinson JS, Mann SA, Robinson CA, Fourney DR : Giant cystic intradural lumbosacral schwannoma: is stabilization necessary? Can J Neurol Sci 37 : 535-538, 2010 https://doi.org/10.1017/S0317167100010623
  30. Zileli M, Isik HS, Ogut FE, Is M, Cagli S, Calli C : Aneurysmal bone cysts of the spine. Eur Spine J 22 : 593-601, 2013 https://doi.org/10.1007/s00586-012-2510-x

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