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CASE REPORT Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 57-58
Intrasacral Schwannoma A case report


Department of Orthopaedics, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India

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How to cite this article:
Ayengar R, Patond K R. Intrasacral Schwannoma A case report. Indian J Orthop 2002;36:57-8

How to cite this URL:
Ayengar R, Patond K R. Intrasacral Schwannoma A case report. Indian J Orthop [serial online] 2002 [cited 2019 Oct 19];36:57-8. Available from: http://www.ijoonline.com/text.asp?2002/36/1/57/35933

   Introduction Top


Intraosseous neurogeneic tumors that too within spinal column are very rare. Not more than 40 cases have been reported. [1] Majority of them occur in the mandible due to the long course of sensory inferior alveolar nerve. [2] Only single cases of lumbar and dorsal intraosseous schwannoma each has been reported in literature till now. [3],[4] Intraosseous schwannoma were also reported in mandible, maxilla and small bones of hand. [5],[6] In view of rare site of lesion and its size a case of intrasacral schwannoma is reported.


   Case Report Top


PB, 37 years male labourer reported with complaints of low backache for one year. The pain was gradually increasing and was severe for last 15 days. There was no history of injury or associated fever. On clinical examination there was no evidence of neurofibromatosis. Local examination revealed restricted straight leg raising test to 60 o on right side and tenderness over lumbosacral articulation along with multiple marks over sacral region. The sensory examination, muscle power and reflexes were normal. X-Rays of lumbosacral spine were also normal. A provisional clinical diagnosis of chronic disc prolapse with radiculitis without neural deficit was made and treated symptomatically. Even after adequate conservative treatment the patient did not improve. MRI of spine including the sacrum reported a large neurofibroma of sacrum about 9 cm in widest dimensions. [Figure 1(a)],[Figure 1(b)]. However, a clinical possibility of cordoma and cystic tuberculosis of sacrum was kept. The patient was subjected to explorative surgery for excision of the tumor.

Subjected to explorative surgery for excision of the tumor. Through median infra-umbilical transperitoneal anterior approach the tumor was exposed. Intra-operatively it was found to be a big firm vascular encapsulated tumor arising inside the first sacral body more on the right side extending to the anterior aspect of the sacrum. The entire tumor was radically curetted and the material was subjected to histopathology. Intra-operatively the tumor had very few fibrous elements. After radical curettage the cavity was packed with polymethyl methacrylate bone cement to prevent local recurrence [Figure 2]. The postoperative period was uneventful and patient was ambulated on third day.

Histopathology revealed elongated and spindle shaped cells arranged in whorls along with palisading nuclei with areas of Antoni type A Schwann cells and with areas of Antoni type B cells. The nuclei were normochromic without mitotic activity. The specimen was stained for nerve fibres, which was negative. The histopathological diagnosis was Schwannoma [Figure 3]. Postoperatively the patient was given radiotherapy of 1600 rads over 12 sittings and followed up at every 2 month. When last seen 2 year later the patient was totally asymptomatic and gone back to this original occupation. Recent radiographs revealed no osteolysis around the bone cement and no recurrence.


   Discussion Top


Intraosseous Schwannomas are uncommon [1] . In the present case right side of S1 sacral body was totally involved by the tumor pathology. The intraosseous origin of tumor is well supported by the gross pathological findings of hallowed out sacrum on the right side. Though it was a benign tumor it was vascular. Intraosseous origin of Schwannomas is suggested by presence of nerve fibres within bones which is well documented in the lumbosacral region. [3]

Curettage and bone cementing provided radical margins with adjuvant as the exothermic process of polymerization of bone cement kills the remaining microscopic tumor tissue. Radiotherapy in form of teletherapy prevents recurrence of the tumor. [7]

 
   References Top

1.Sherman M. The nerves of bone. J Bone Joint Surg [Am] 1963; 45-A: 522-528.  Back to cited text no. 1    
2.Samter TG, Vellios F, Shafer WG. Neurilemmoma of bone. Report of 3 cases with review of literature. Radiol 1960; 5: 215-222.  Back to cited text no. 2    
3.Dickson JH, Waltz TA, Fechner RE. Intraosseous neurilemmoma of the L1 vertebral body. J Bone Joint Surg [Am] 1971; 53-A: 349-355.  Back to cited text no. 3    
4.Reddy GV, Chari PR. Intraosseous neurilemmoma of D 7 vertebral body with paraplegia. Ind J Orthop 1999; 33: 148-150.  Back to cited text no. 4    
5.Friedman M. Intraosseous schwannoma. Report of case. Oral Surg 1964; 18: 90-96.  Back to cited text no. 5    
6.Fawcett KJ, Dahlin DC, Gardner E. Neurilemmoma of bone. Am J Clin Pathol 1968; 47: 759766.  Back to cited text no. 6    
7.De Vitta VT Jr, Hellman S, Rosenberg SA. In Cancer: Principles & practice, 5 th Ed, Lipponcott Raven; New York 1977: 2069.  Back to cited text no. 7    

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Correspondence Address:
K R Patond
7/111, Vivekanand Block, KHS, Sewagram - 442 102, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure 1(a)], [Figure 1(b)], [Figure 2], [Figure 3]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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