A Long Segmental Hemorrhagic Spinal Schwannoma with Atypical Presentation

Acute hemorrhagic presentation of spinal schwannoma is an event rarely seen. We had ever reported a 63-yearold male presenting with acute spinal cord compression caused by a long segment of intradural extramedullary schwannoma with hemorrhage and atypical enhancement pattern. The magnetic resonance image findings included a long segmental irregular contour, intermediate signal intensity on T1-weighted images, heterogeneous and foci of low signal intensity on T2-weighted images and segmental enhancement of the lesion, all of which is highly atypical for schwannoma. Emergency surgical decompression was performed and the pathologic results have proved the existence of spinal schwannoma. Correspondence Author to: Joseph-Hang Leung Department of Radiology, Chiayi Christian Hospital, Chiayi, Taiwan No. 539, Jhong-Siao Road, Chiayi 600, Taiwan J Radiol Sci 2011; 36: 191-194 Atypical hemorrhagic spinal schwannoma 192 J Radiol Sci September 2011 Vol.36 No.3 images (Fig. 1b, 1c). On gadolinium-enhanced T1-weighted images showed lobulated enhancement pattern (Fig. 1d, 1e). So, the initial impression was ependymoma with spinal cord compression. Other differential diagnosis was astrocytoma, meningioma and hemangioblastoma. Then the patient was admitted to surgical intensive care units and the operation was done for emergency decompression of the spinal cord. Laminectomy was performed from thoracic vertebrae T7 to T12 level with subtotal excision of the intradural extramedullary tumor. Intra-operatively, the tumor was found as yellowish, easy bleeding with a thin wall capsule and intra-tumoral hematoma. Grossly, the specimen consisted of multiple pieces of gray white soft tumors measuring up to 1.8 × 1 × 0.5 cm. Microscopic findings showed a picture of schwannoma, composed of Antoni A areas and Antoni B areas (Fig. 2). Hyalinosis of the vessels and Verocay’s bodies were noted. Reoperation was done due to residual tumor being detected in the follow up MRI. After the operation, the neurological condition was not recovered. Paraplegia with myoclonus on left leg was found. So, he was consulted for rehabilitation. MRI obtained 6 months after surgery, revealed no residual or recurrent tumor.