Large lumbosacral schwannoma in a young female- a case report from Afghanistan

Abstract

Introduction: Mobile Schwannoma is a rare soft tissue tumor that commonly involves the elderly population. It has no cellular material and grows as solitary, firm, oval, encapsulated benign tumors from the sensory (dorsal) nerve root. If multiple, they are usually associated with Neurofibromatosis type 2 (NF-2). The initial sign and symptoms include segmental pain and paresthesia. It may lead to myelopathy if the tumor expands.

Case presentation: We present a twenty-year-old female with chronic lower backache radiating to the ipsilateral thigh with no urinary or fecal incontinence. On physical examination, the ankle reflex was hypoactive on the left side, and the straight leg raise test was positive. A large 32 × 15 × 14 mm heterogeneous enhancing focal lesion was found on the posterior side of L5 and S1 vertebrae with severe central canal stenosis. A diagnosis of nerve sheath tumor was made based on contrast MRI pre-operatively. The underlying cause was a nerve sheath tumor. A total bilateral laminectomy at the L1-S5 level and mass excision was performed, preserving nerve roots. The postoperative period was uneventful, and no tumor re-growth was noticed.

Clinical discussion: Schwannoma is a slow-growing tumor; benign; usually, less than 8 cm in diameter tumor, commonly found in the head and neck region. It is the 3rd most common soft tissue tumor and the 2nd most common intradural extramedullary tumor. In our report, a young, non-Caucasian female patient is diagnosed with schwannoma, which is quite rare. In our case, a larger tumor of size 32 × 15 × 14 mm was noted, affecting the posterior body of L5 and S1 vertebrae in the left lateral recess with impingement of the left S1 traversing nerve root. Around 29% of spinal root nerve tumors are schwannomas. As the tumor grows slowly, the diagnosis may be delayed.

Conclusion: Schwannoma is a slow-growing solitary, firm, oval, encapsulated benign tumor arising from the sensory (dorsal) nerve root. Histopathology plays a vital role in diagnosis, and overall, the disease has a favorable prognosis. Therefore, an appropriate approach is necessary to rule out the disease.

Keywords: Benign tumor; Laminectomy; Lumbar spine; Nerve sheath tumor; Schwannomas.