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Acute Macrocystic Thoracic Schwannoma: Systematic Review and Illustrative Case Example
Grace R Fassina1, Spencer J Oslin1, Helen H Shi1
1Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, USA.
Background:
Schwannomas are benign peripheral nerve sheath tumors arising from myelinating Schwann cells. Although macrocystic changes are regularly encountered in schwannoma variants such as vestibular nerve tumors, they are exceedingly rare among spinal neoplasms.
Methods:
Case report and systematic review of 4 databases (Ovid Medline, PubMed, Science Direct, and SCOPUS) from inception to present. All peer-reviewed publications reporting intradural cystic thoracic schwannoma were included.
Results:
We identified 8 publications documenting 9 cases of cystic thoracic schwannoma. Four were female, 5 male; median age was 41 years (range, 27-80). Presentations ranged from incidental to pain, sensory changes, lower extremity paresis, or bowel/bladder dysfunction. Characteristic radiographic findings included T1 hypointensity, T2 hyperintensity, and cord effacement or compression. The present case followed a similar pattern: a 52-year-old male presented with worsening bilateral lower extremity weakness, low back pain, and gait dysfunction, worsening over 3 days. Examination also revealed decreased left lower extremity sensation. Imaging identified a well-delineated intradural, extramedullary macrocystic extending over T7-T10. The patient underwent a laminectomy resulting in complete tumor resection and restoration of intact neurologic function. Final pathology confirmed benign cystic schwannoma.
Conclusions:
Macrocystic thoracic schwannomas are exceedingly rare and lack a comprehensive scheme for clinical classification of their natural history and pathogenesis. We report the 10th case of such a schwannoma, and the first associated systematic review. Although macrocystic thoracic schwannomas are not frequently encountered, accurate diagnosis and appropriate neurosurgical treatment is critical in these vulnerable patients, given the opportunity for excellent functional outcomes following neurosurgical treatment.
Insights
Macrocystic thoracic schwannomas are rare spinal tumors. This case report and review highlights their rarity and emphasizes the importance of accurate diagnosis and surgical treatment for excellent patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Schwannomas are benign peripheral nerve sheath tumors originating from Schwann cells.
- Macrocystic changes are common in some schwannoma variants but rare in spinal neoplasms.
Approach:
- A systematic review of 4 databases (Ovid Medline, PubMed, Science Direct, SCOPUS) was conducted.
- All peer-reviewed publications reporting intradural cystic thoracic schwannoma were included.
Key Points:
- Nine cases of cystic thoracic schwannoma were identified across 8 publications.
- Patients presented with varied symptoms including pain, neurological deficits, and bowel/bladder dysfunction.
- Radiographic findings typically showed T1 hypointensity and T2 hyperintensity, with cord compression.
Conclusions:
- Macrocystic thoracic schwannomas are exceptionally rare, lacking established classification schemes.
- Accurate diagnosis and timely neurosurgical intervention are crucial for optimal patient outcomes.
- This study reports the 10th case and the first systematic review of this rare spinal tumor.
