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Schwannoma with vertebral scalloping

Case contributed by Roberto Schubert
Diagnosis certain

Presentation

History withheld.

Patient Data

Age: 35 years

Lumbar spine

ct

Large intra-extradural mass eroding the borders of the right neuroforamen and the dorsal contour of the L4 vertebral body. Marked rim sclerosis suggests a non-aggressive lesion.

Lumbar spine

mri

MRI shows a T2-hyperintense, somewhat heterogeneous lesion, that enhances avidly, but only at the periphery.

Case Discussion

Biopsy-proven Schwannoma at the L4 level on the right known for several years. The patient refused operative treatment.

In contrast with osteolysis, scalloping is characterized by a smooth margin with rim sclerosis towards the spinal canal. In the spine, it is caused by a mismatch between intra-spinal pressure and bone stability. Systemic disorders, that may lead to vertebral scalloping are connective-tissue diseases, mucopolysaccharidoses, neurofibromatosis type I or ankylosing spondylitis. Localized scalloping may also be caused by slowly growing intraspinal masses 1.

MR images courtesy of Dr. Christoph Gill.

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