Presentation
Progressive weakness of the lower limbs.
Patient Data
Well-defined sausage-shaped intradural extramedullary mass at T12-L1 level of right lateral location measuring 68 X 19 X 17 mm. It elicits an isosignal to the spinal cord on T1, high signal on T2 and STIR with vivid heterogeneous enhancement on postcontrast sequences. The conus medullaris is compressed and displaced to the left with mild edema. No extension is seen through the adjacent foraminal recess. Associated adjacent vertebral bony scalloping.
Case Discussion
MRI features of an intradural extramedullary mass at T12-L1 level compressing and displacing the conus medullaris with cord edema and vertebral scalloping suggestive of spinal schwannoma.
The patient went to have complete resection of the tumor with a histopathological exam and immunohistochemistry study that confirm the diagnosis of schwannoma.
The most common primary intradural extramedullary neoplasms are meningioma (20-30%) and schwannoma (15-50%), followed by neurofibroma.
Schwannomas are usually indistinguishable from neurofibromas, however, schwannomas are frequently associated with hemorrhage, intrinsic vascular changes, cyst formation and fatty degeneration. These findings are rare in neurofibromas.
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