Abstract

Background: Schwannoma is a typically benign nerve sheath tumor. Here, a 30-year-old female underwent resection of a benign retroperitoneal/intra/paraspinal schwannoma.

Case Description: A 30-year-old female originally had urological surgery to remove an ill-defined retroperitoneal tumor. When she newly presented with right-side low back pain, and the magnetic resonance documented a recurrent/residual L1–L3 intra/paraspinal lesion, she required an additional tumor excision for the removal of the benign schwannoma.

Conclusion: Spinal surgeons, dealing with benign schwannomas located in the retroperitoneal/intra/paraspinal compartments, need to work collaboratively with other surgeons (i.e., in this case, urologists) to achieve gross total tumor excision, and the best long-term results.

Keywords: Paraspinal, Schwannoma, Tumor

INTRODUCTION

Benign spinal schwannomas account for 25% of all spine tumors (i.e., 0.3–0.5/100,000). They are typically located extradurally, or in the intradural/extramedullary compartment (i.e., 0.3–0.5/100,000).[ 1 , 2 , 5 , 6 , 9 ] Magnetic resonance (MR) scans with/without contrast are the diagnostic procedures of choice. Surgery should consist of a gross resection to obtain optimal long-term results.[ 3 , 8 ] Here, a 30-year-old female underwent the initial removal of a benign retroperitoneal tumor by urology. When the subsequent MR documented an L1–L3 combined intra/paraspinal lesion, the patient successfully underwent a tumor excision for gross total resection of benign schwannoma.[ 8 ]

CASE PRESENTATION

A 30-year-old female presented with 3 months of low back pain. Previously, urology had partially resected an undefined tumor in the peritoneal cavity. When she still complained of low back pain postoperatively, a lumbar MR was performed. It revealed a right-sided intra/paraspinal retroperitoneal hypointense mass on the T1-weighted and inhomogeneous hyperintense lesion on the T2-weighted study that was homogeneously enhanced with contrast [ Figures 1 and 2 ]. The lesion compressed the lateral/foraminally exiting L1–L3 nerve roots and the right kidney. She underwent an L1–L3 gross total surgical excision. Macroscopic features of the tumor can be seen in Figure 3 .

Figure 1:

Magnetic resonance imaging examination of the (a) axial T1 and (b) axial T1 with contrast.

Figure 2:

Magnetic resonance imaging examination of the (a) axial, (b) sagittal, and (c) coronal section of the T2-weighted sequence showed an extradural mass lesion that extended to the peritoneal cavity.

Figure 3:

Macroscopic features of the tumor. It appears as a rubbery, friable brownish tissue.

Pathology

The histopathology was consistent with a benign schwannoma. Slides revealed partial palisading/cells arranged in longitudinal/transverse bundles containing monomorphic features, medium cytoplasm, and round and/or oval spindle nuclei. To confirm the findings, S100 immunohistochemistry demonstrated high-intensity positive staining of the nucleus/cytoplasm involving most tumor cells. Additional spinal muscular atrophy staining of tumor cells was negative. Microscopic features of the tumor can be seen in Figure 4 .

Figure 4:

Microscopic features of the tumor. It reveals the densely arranged spindle cells (Antoni A) and the hypocellular cells (Antoni B).

Postoperative course

The patient had less pain on the 1^st day following the postoperative day, and all symptoms/signs resolved within 1 week. At 3 postoperative months, she remains disease-free.

DISCUSSION

Gross total excision of spinal schwannomas is the treatment of choice.[ 3 - 5 , 7 ] Here, the patient was initially treated by urology with a partial resection of a retroperitoneal schwannoma. Due to persistent pain, a lumbar MR was obtained that showed L1–L3 lateral/foraminal tumor extension. She then successfully underwent secondary gross total intra/paraspinal tumor removal. The tumor has not recurred within 3 postoperative months.[ 6 ] The literature shows that spinal schwannomas are typically benign extradural or intradural/extramedullary lesions that are effectively treated with initial gross total resection [ Table 1 ].

Table 1:

Summary of schwannoma cases from published articles.

CONCLUSION

A 30-year-old female originally underwent resection of an intraperitoneal schwannoma by urology. When symptoms of low back pain persisted, and the lumbar MR identified a right-sided L1–L3 intra/paraspinal extension of the lateral/foraminal mass, the patient successfully underwent secondary gross total tumor resection.

Ethical approval

The Institutional Review Board approval is not required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

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