Presentation
Right sided sciatica.
Patient Data
MRI performed at another institution was reported as demonstrating a right S1 enhancing lesion, likely a neurogenic tumor.
The brain, cervical, and thoracic spine (not shown), as well as the lumbar spine, are unremarkable, with no further areas of abnormal enhancement.
Enhancement is closely related to the right S1 nerve root slightly smaller than before. It does not appear intrinsic to the nerve root but rather appears to relate to a disc extrusion through a right posterolateral L5/S1 annular defect.
Conclusion:
Enhancement related to the right S1 nerve root in the subarticular recess at L5/S1 is similar to before, but likely granulation tissue surrounding and a disc extrusion from the right L5/S1 disc rather than a tumor.
Case Discussion
The patient went on to have a discectomy.
Histology
Sections show fragments of fibrocartilage consistent with nucleus pulposus interspersed with some areas of fibrovascular tissue. There is no significant inflammation. There is no evidence of a neoplastic process.
Discussion
It is important to remember that disc extrusions can have significant enhancement and can mimic tumors. Good quality imaging is essential if communication with the disc space is to be visualized.
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