Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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July 16, 2020
Intraosseous Schwannoma
- Background:
- Spinal schwannomas typically present as extramedullary, intradural tumors.
- Intraosseous schwannomas account for less than 0.2% of primary bone tumors.
- Clinical Presentation:
- Patients present with pain and radiculopathies.
- Key Diagnostic Features:
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Schwannomas classically appear as well-circumscribed masses which displace adjacent structures without direct invasion.
- They typically demonstrate low to intermediate attenuation on CT with intense enhancement.
- On MRI, these lesions appear iso- to hypointense on precontrast T1 and heterogeneously hyperintense on T2. They also intensely enhance on MRI.
- Larger tumors may have cystic degenerative areas.
- This lesion demonstrates a characteristic enhancing lesion within an expanded left C2–C3 neuroforamen. In this rare anatomic variant, the intraspinal component of the tumor erodes into the posterior C2 vertebral body.
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- Differential Diagnoses (enhancing vertebral body lesions with epidural extension):
- Plasmacytoma: Often characterized by marked erosion, expansion, and destruction of the bone cortex
- Metastatic disease: Commonly multifocal without well-circumscribed enhancement margins
- Giant cell tumor: Typically demonstrates heterogeneous T2 and enhancement characteristics
- Treatment:
- Surgical resection/debulking with spinal stabilization
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