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Samuel Nodal1, Adham M. Khalafallah1, Joseph Yunga Tigre1, Sakir Humayun Gultekinm2, Bhavjeet Singh Sanghera1, Allan D. Levi1, S. Shelby Burks1
  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, United States
  2. Department of Pathology, University of Miami Miller School of Medicine, Miami, United States

Correspondence Address:
Samuel Nodal, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, United States.

DOI:10.25259/SNI_267_2025

Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Samuel Nodal1, Adham M. Khalafallah1, Joseph Yunga Tigre1, Sakir Humayun Gultekinm2, Bhavjeet Singh Sanghera1, Allan D. Levi1, S. Shelby Burks1. Resection of a rare lumbar epithelioid schwannoma. 16-May-2025;16:188

How to cite this URL: Samuel Nodal1, Adham M. Khalafallah1, Joseph Yunga Tigre1, Sakir Humayun Gultekinm2, Bhavjeet Singh Sanghera1, Allan D. Levi1, S. Shelby Burks1. Resection of a rare lumbar epithelioid schwannoma. 16-May-2025;16:188. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13552

Date of Submission
16-Mar-2025

Date of Acceptance
15-Apr-2025

Date of Web Publication
16-May-2025

Abstract

Background: Schwannomas, along with meningiomas, constitute the most common type of intradural extramedullary tumors. They are rare, typically benign tumors that originate from Schwann cells. Symptoms and signs attributed to these tumors may include back/radicular pain, focal motor and/or sensory deficits, and bowel/bladder dysfunction. It is essential to obtain pathological confirmation of this lesion and to differentiate it from other benign (i.e., neurofibromas, lipomas, ganglion cysts, meningiomas, and giant cell tumors), and/ or infrequently malignant lesions (i.e., malignant peripheral nerve sheath tumors, and sarcomas). Epithelioid Schwannomas/Benign Epithelioid Schwannomas (BES) is a benign, rare histologic subtype of schwannoma that resembles epithelial cells and lacks classic features such as Antoni A and Antoni B areas.

Case Description: A 29-year-old female presented with 1 year of severe, constant, sharp back pain (i.e., 5–10/10) that radiated down the left lower extremity. She also experienced bilateral leg numbness and tingling, along with weakness in the hips and right lower extremity. Diclofenac failed to provide any pain relief. Notably, symptoms progressed despite the utilization of physical therapy. Her neurological examination showed mild weakness (4+/5) in the left tibialis anterior and extensor hallucis longus distributions. The magnetic resonance imaging revealed a heterogeneously enhancing circumferential intradural extramedullary mass at the L2 level that caused cauda equina compression. The patient underwent an L1–L2 laminectomy, which was recommended for tumor resection. Pathologically, the lesion proved to be a BES; the epithelial cells stained positive for S-100. Three months postoperatively, the patient is asymptomatic.

Conclusion: BES is a rare subtype of schwannoma. Patients with these lesions should undergo gross total tumor resection to achieve the best long-term postoperative outcomes.

Keywords: Epithelioid schwannoma, Gross total removal, Laminectomy, Lumbar schwannoma, Operative video, Pathology, Surgical resection

Video 1


Annotations[1-6]

0:07 – Case presentation

1:13 – Neuroimaging findings

2:35 – Surgical steps

3:15 – Surgical video

6:19 – Background

7:24 – Review of clinical outcome

7:58 – Pathology

8:33 – References

Ethical approval:

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 author confirms 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.

Video available on:

https://doi.org/10.25259/SNI_267_2025

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.

References

1. Belakhoua SM, Rodriguez FJ. Diagnostic pathology of tumors of peripheral nerve. Neurosurgery. 2021. 88: 443-56

2. Fehlings MG, Nater A, Zamorano JJ, Tetreault LA, Varga PP, Gokaslan ZL. Risk factors for recurrence of surgically treated conventional spinal schwannomas: Analysis of 169 patients from a multicenter international database. Spine (Phila Pa 1976). 2016. 41: 390-8

3. Hilton DA, Hanemann CO. Schwannomas and their pathogenesis. Brain Pathol. 2014. 24: 205-20

4. Koeller KK, Shih RY. Intradural extramedullary spinal neoplasms: Radiologic-pathologic correlation. Radiographics. 2019. 39: 468-90

5. Nazwar TA, Balafif F, Wardhana DW, Mustofa M. Spinal schwannoma: A review of the literature. Ro J Neurol. 2024. 23: 98-105

6. Rezanko T, Sari AA, Tunakan M, Calli AO, Altinboga AA. Epithelioid schwannoma of soft tissue: Unusual morphological variant causing a diagnostic dilemma. Ann Diagn Pathol. 2012. 16: 521-6

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