Giant lumbosacral schwannoma

[摘要] Background:The spinal schwannoma is a tumor of the nerve sheaths that presents in intraduraland extramedular areas. It comes from the embryonic cells of the neural crestof the peripheral nerves. They represent 25-30% of tumors and it affects adultsaging 40 and 60. It is rare in children and there is no sex difference. Objective: Present a case of giant lumbosacral schwannoma that was diagnosedat Manuel Ascunce Domenech University Hospital in Camagüey. This patientreceived surgical treatment at the National Institute of Neurology and Neurosurgery. Case report: 38-year-old white male patient with a history of lumbosacralpain of two years of evolution came to consultation. His pain intensified inthe last 8 months, radiating to lower limbs with paresthesias and loss of musclestrength. In addition, he had constipation, urinary incontinence, difficultyat walking, and delayed ejaculation. Computed tomography revealed an extensiveintrarectal tumor process with anterior, posterior and lateral longitudinalgrowth from the fourth lumbar vertebra to the third sacrum (L4-S3), which producedlysis of the posterior portion of the vertebral bodies, pedicles, and S3 anteriorborder. Magnetic resonance imaging revealed a large area slightly hypointensein T1 and hyperintense in T2, which occupied the vertebral canal from L3 tothe fourth sacral vertebra (S4). The biopsy reported a tumor-like fusocellularcells arrangedin compact fascicles, other more lax areas of clear cytoplasm cells, abundantblood vessels, compatible with a schwannoma, benign tumor of the nerve sheaths.The patient was referred for surgical treatment at the National Institute ofNeurology and Neurosurgery with favorable evolution after extensive resectionand instrumentation.Conclusions:Lumbosacral schwannoma is a challenge for surgeons. Sacral involvement is rare.Histopathologic diagnosis is fundamental and surgery is the treatment of choice,in which complete resection of the tumor is very difficult at times due to thepossibility of injuring important nerve structures. Radiological follow-up isrecommended for the risk of relapses.

[学科分类] 生理学

[关键词] Lumbosacral giant schwannoma;neurilemoma;tumor of nerve sheaths;surgicaltreatment.