J Korean Soc Radiol.  2014 Jul;71(1):1-5. 10.3348/jksr.2014.71.1.1.

A Purely Cystic Giant Sacral Schwannoma Mimicking a Bone Cyst: A Case Report

• Lee HA
• Jeon SJ
• Choi SS
• Kim HW
• Kim HS

• KMID: 1709013
• DOI: http://doi.org/10.3348/jksr.2014.71.1.1

Abstract

Schwannomas are benign tumors arising from the myelinated nerve sheath. These tumors are generally solid, and degenerative changes can occur. However, cystic degeneration is usually noted only in parts of the tumor, and complete cystic change is rare; only a few such cases have been reported. To our knowledge, only one case of a completely cystic giant schwannoma in the lumbosacral area has been reported. Here, we report a similar case with the descriptions of the magnetic resonance imaging and pathological findings.

MeSH Terms

Bone Cysts*
Magnetic Resonance Imaging
Myelin Sheath
Neurilemmoma*
Neuroimaging

Figure

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  Fig. 1 Lumbar spine computed tomography imaging. A. Sagittal image shows a well-defined osteolytic mass at the sacral region (L5-S2). B. Axial image shows that the mass had a lobulated margin and extended to the intraosseous area of S1 and the epidural space.

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  Fig. 2 Lumbar spine magnetic resonance imaging. A, B. Sagittal T2-weighted images show a well-defined, unilocular cystic mass. This mass had a fluid-fluid level (or a fluid-debris level) (arrow) and extended to the presacral area (arrowheads). C. Axial T2-weighted image shows that this mass was a purely cystic mass. D. Sagittal T1-weighted image shows the fluid-fluid level (arrow). E. Fat-suppressed contrast enhanced T1-weighted sagittal image shows thin rim enhancement of the cystic mass.

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  Fig. 3 Microphotography. A. Microphotography (H&E stain, × 40) shows a predominantly cystic component with extensive degeneration and hemorrhage. B. Microphotography (H&E stain, × 100) presents two distinct types of tissue patterns: Antoni A, where the spindle cells are arranged in a relatively compact palisading pattern, and Antoni B, comprising loose, reticular, often cystic arrangements.

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