J Korean Neurosurg Soc.  2013 Oct;54(4):350-354. 10.3340/jkns.2013.54.4.350.

Cystic Giant Sacral Schwannoma Mimicking Aneurysmal Bone Cyst : A Case Report and Review of Literatures

• Cho DY
• Hur JW
• Shim JH
• Kim JS

• KMID: 1499344
• DOI: http://doi.org/10.3340/jkns.2013.54.4.350

Abstract

To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.

Keyword

Giant schwannoma; Sacrum; Cystic degeneration; Aneurysmal bone cyst

MeSH Terms

Aneurysm*
Bone Cysts*
Diagnosis, Differential
Humans
Leg
Magnetic Resonance Imaging
Middle Aged
Neurilemmoma*
Sacrum

Figure

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  Fig. 1 Simple radiograph shows "ballooning" of osteolytic lesion involving left sacral ala (black arrows) without lumbar spine involvement.

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  Fig. 2 A : MR imaging shows 5.1×3.4×3.6 cm sized multiloculated cystic mass with bony expansion into left S1 body. Lt. S1 root compression is also seen. The mass is seen as homogenous hypointense signal on T1-weighted image and hyperintense signal on T2-weighted image. B : Multi-septated cystic rim enhancement with gadolinium contrast enhancement is noted but no definite solid portion was found.

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  Fig. 3 Axial and sagittal CT scan reveal an intraosseous expensile mass involving left sacrum. Compression of the left S1 nerve root and displacement (arrowhead) of the left sacral nerves below S1 nerve is noted. Subtle pathologic fracture involving upper-endplate of S1 is also seen (arrow).

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  Fig. 4 A : Intraoperative image of before tumor dissection (* : cystic tumor capsule, → : S1 nerve root). B : Intraoperative image of after complete tumor removal. C : Pathologic specimen of tumor cystic capsule.

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  Fig. 5 Postoperative plain film. Lumbosacral reconstruction involving transpedicular screw fixation of L4-S1 and bilateral trans-iliac screws was done. Lt. S1 level was omitted due to pedicle invasion.

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  Fig. 6 Postoperative enhanced MR imaging revealed complete resection of tumor.

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  Fig. 7 Histopathology of tumor. A : Spindle-shaped cells with pale, eosinophilic cytoplasm arranged in 2 characteristic patterns : Antoni A and B (H&E, original magnification ×50). B : Several Verocay bodies with nuclear palisading (H&E, original magnification ×50).

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