Brain Tumor Res Treat.  2019 Oct;7(2):160-163. 10.14791/btrt.2019.7.e34.

Intratumoral Hemorrhage of the Cervical Spinal Schwannoma Presenting: Acute Quadriparesis

• Jung GS
• Lee YM
• Kim YZ
• Kim JS

• KMID: 2461192
• DOI: http://doi.org/10.14791/btrt.2019.7.e34

Abstract

Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.

Keyword

Hemorrhage; Schwannoma; Intradural extramedullary; Cervical

MeSH Terms

Adult
Emergencies
Hemorrhage*
Humans
Magnetic Resonance Imaging
Male
Neck Pain
Neurilemmoma*
Quadriplegia*
Spine

Figure

• 

  Fig. 1 Preoperative sagittal (A) and axial (B) T2-weighted MRI shows well-defined, lobulating, heterogeneously mixed signal intensity mass lesion at central spinal C2–C3 level on the right side. Contrast enhanced T1-weighted MRI with mild enhancement in sagittal (C) and axial (D) view.

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  Fig. 2 Overall appearance of the hemorrhagic tumor. The darkreddish mass was removed en-bloc.

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  Fig. 3 Histopathological findings of the Schwannoma. A: Hematoxylin-eosin (×100) stain shows ectatic vessels with hemorrhage. B: Hematoxylineosin (×200) stain shows short fascicles with nuclear palisading resembling Verocay body of conventional schwannomas. C: Hematoxylineosin (×400) stain shows the Schwann cell nuclei which are large and hyperchromatic due to degeneration.

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  Fig. 4 Postoperative sagittal (A) and axial (B) T2-weighted MRI showing no residual tumor

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