Sacral schwannoma with intraosseous extension

• Published in: BMJ case reports Vol. 12; no. 1; p. e227095
• Main Authors: Silva, Carlos Dias, Mateus, José Eduardo, Silva, Joana Oliveira, Vaio, Teresa
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-01-2019; BMJ Publishing Group
• Subjects: Abdomen; Bone cancer; Case reports; Humans; Images In; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Medical imaging; Neoplasm Invasiveness; Neurilemmoma - diagnostic imaging; Neurilemmoma - surgery; Neuroimaging; Neurosurgery; Pain; Positron Emission Tomography Computed Tomography; Sacrum - diagnostic imaging; Sacrum - surgery; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - surgery; Tumors; Young Adult; neurooncology; neurosurgery; radiology; neuroimaging
• DOI: 10.1136/bcr-2018-227095
• EISSN: 1757-790X

Physical examination revealed fever (38.8°C) and inferior abdominal and lower back pain on percussion. Positron emission tomography/CT scan revealed a large osteolytic lesion with soft tissue component (figure 1B) measuring 7.0×5.7×6.0 cm and causing scalloping at the surrounding bone in the left sacral wing with heterogeneous 18F-labelled fluoro-2- deoxyglucose uptake, as well as a mesenteric ganglion. Complete excision is the treatment of choice but is frequently difficult to achieve because of its localisation and considering the importance to avoid inadvertent injury to adjacent nerves and vessels.1–3 Learning points Although generally benign, schwannomas may be difficult to distinguish from malignant peripheral nerve sheath tumours but also other tumours (eg, osteosarcoma) solely by imaging techniques, often leading to a lesion biopsy.