Mobile thoracic schwannoma combined with intraosseous schwannomas: A case report

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.

Figure 1

Serial preoperative magnetic resonance imaging. (A) T1-weighted imaging; (B) T2-weighted imaging; (C) Gd-DTPA contrast imaging) showed an intradural extramedullary tumor (red arrow) at the T5-6 levels and 2 intraosseous tumors at the T7-8 levels (red arrow).

Figure 2

Pathological examination of the intraosseous tumors at the T7-8 levels showed schwannomas (The original magnification was 200×.).

Figure 3

Postoperative magnetic resonance imaging showed that the intraosseous tumors had been removed while the intradural extramedullary tumor (red arrow) had moved from the T5-6 levels to the T3-4 levels.

Figure 4

(A and B) After a dural incision at the T2-3 levels (white arrow), we failed to find the tumor. (C) After the dura at the T1-2 levels was incised longitudinally (white arrow), the tumor was found.

Figure 5

The tumor (1.7 cm×0.8 cm) was completely resected.

Figure 6

Pathological examination of the extramedullary intradural tumor at the T1-2 levels showed a schwannoma (The original magnification was 200×).