Primary Diagnosis

Nerve sheath tumor, schwannoma

Secondary Diagnosis

Intradural Space

Diagnosis Discussion

This is an intradural-extramedullary neoplasm. Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) comprise the overwhelming majority this subset of spinal tumors. Meningiomas arise from the arachnoid mater (a thin covering layer of the spinal cord which is located inside the dura), and are most common in middle aged and elderly women. Schwannomas and neurofibromas arise from the nerve roots which come off the spinal cord. Meningiomas and nerve sheath tumors are usually benign. Filum terminale ependymomas arise at the base of the spinal cord and may be large and adherent to many nerves, making total removal sometimes difficult. Spinal tumors may cause a variety of symptoms depending on their type, location, and rate of growth. In general pain in the neck or back followed by neurological problems, such as weakness or numbness of the arms or legs or a change in the normal bowel or bladder habits, is most common. In patients already diagnosed with cancer of another area of the body, the new onset of spinal pain may indicate a spinal fracture caused by weakening of the vertebrae by metastatic tumor. Tumors which arise inside the dura are rarely metastatic and are usually slow growing. Patients with these types of tumors may have pain for years before any neurological problems occur. The imaging characteristics; solitary mass with uniform enhancement favors schwannoma as the primary diagnosis. Meningioma and myxopapillary ependymoma should also be entertained.

General Anatomic Area:

Lumbar

Secondary Anatomic Area:

Intradural Space

Disease Category:

Neoplastic - primary

Contributor:

AE Flanders, MD

Date:

01/01/2004

Difficulty Level:

Easy

Pathology Confirmed?:

Yes
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ACR Category Number:

N/A

Keywords:

perineural fibroblastoma, neurofibroma, phakomatosis,nerve sheath tumor