Schwannoma of the lumbar spine, presenting with pain of the
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A 10 year old girl was referred for treatment with RF ablation of an osteoid osteoma of the right knee. Her past medical history was a 6 month duration of severe pain, localized on the right knee, exacerbating during the night, making her unable to sleep. She was a normally developing girl, participating in sports activities until the appearance of pain.

Two X-ray examinations of the right knee were taken in an attempt to define a diagnosis for the knee pain. An area of a small subperiosteal lucency of the lateral femoral condyle was reported. The right knee was further investigated with MRI. There was minimal edema, possible small nidus, and absence of bone sclerosis. She was suggested with a diagnosis of a subchondral osteoid osteoma. The girl was provided with paracetamol and ibuprofen but the pain remained unchanged.

An MRI and a CT examination were undertaken with slices of 5 mm, but a nidus or sclerosis could not be identified. A bone scan was performed that had no increased uptake in the right knee. The bone scan had normal uptake throughout the body. We informed the patient's family that we would not precede to ablation. An MRI investigation was done of the right femur, pelvis, and lumbar spine in an attempt to find possible pathological signs.

In the lumbar spine an oval, intradural extramedullary, tumefactive lesion was observed in the thecal sac, at the level of L1 vertebra. The lesion consisted of a cystic central part and a solid peripheral part, with intense enhancement of the latter. There is no evident extension of the lesion in the foramina. The mass measured 27.5 mm X 17.5 mm X 13 mm.

The lesion appeared to be mainly located in the central and left part of the thecal sac, causing pressure to the roots of cauda equina. The imaging findings were mostly consistent with a tumor of neurogenic origin (schwannoma). With the diagnosis of schwannoma of the spine, the family was informed about the need for surgical treatment of the tumor. Neurosurgical team performed the operation. After posterior laminectomy of L1 and L2, a well?defined capsulated tumor was resected after clear separation from the nerve roots.

Histopathological and immunohistochemical analyses confirmed the diagnosis of a cellular neurilemmoma. The patient showed impressive recovery, feeling completely relieved. Peripheral neurological examination remained normal. A new MRI of the spine in 6 months was performed, with no elements of recurrence. The girl 8 months after the operation has not experienced any pain. The MRI examination of the brain was normal and neurofibromatosis was excluded.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3503?af=R
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