Presentation
Sciatica
Patient Data
The well circumscribed S2 enhancing mass is with areas of T2 hyper intensity (presumably representing cystic change) is demonstrated.
L5/S1 extensive facet joint degenerative change, most marked on the right where enhancement and inflammatory change is demonstrated.
There is no significant neural exit foraminal stenosis or canal stenosis, with only small broad based disc protrusions thoracolumbar spine. The conus terminates at L1/2 and is normal in appearance. No other enhancing mass is identified.
Conclusion: S2 neurogenic tumor, probably a schwannoma.
Case Discussion
The patient went on to have a resection.
Histology
Paraffin sections show a moderately hypercellular neurilemmoma (schwannoma) composed of both Antoni-A and B type tissues. Well-formed Verocay bodies are noted in Antoni A areas. Tumor cells show mild nuclear and cellular pleomorphism. No mitotic figures, densely hypercellular areas or areas of necrosis are identified.
FINAL DIAGNOSIS: right S2 nerve root schwannoma.
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