A huge cystic schwannoma with destruction of vertebra derived from the l-1 right nerve root accompanied with neurologic symptoms —report of a case—

Abstract

The patient was a 55-year-old male who had a one-year history of slowly-progressing lumbago, numbness and hypoesthesia at a lower half of the body and claudication. Plain X-ray, CT, MRI and angiographies revealed an irregular dumbbell-shaped mass at the L-1 lumbar nerve root irregularly involving the vertebura, and evolving into the retroperitoneum to form a continuing large mass with large cystic change. The mass was 22cm in diameter. A part of the mass in the retroperitoneum strongly compressed the abdominal organs and displaced the liver, kidney and inferior vena cava toward cranial, foot, and left direction, respectively.
The mass was resected with two stage operations. Firstly, a part of the mass at the lumbar root was resected through the back approach leaving a retroperitonal part. Secondly, under lapalotomy, the residual large part of the mass in the retroperitoneum and in the back masses was extirpated. Histologically, the tumor was composed of spindle-shaped neoplastic cells. The tissue revealed vimentin (+), actin (+), α1-ACT (+), S100 (+), C-kit (-), and MIB-1 was 7%. Benign schwannoma was thus diagnosed.
The symptoms disappeared immediately after the removal of the mass. No apparent loss of motor function was observed after the therapy.