Abstract
IntroductionSchwannomas are rare encapsulated tumors that derive from the nerve sheath and should be removed due to their infrequent, but existent possibility of malignancy.Case presentationWe report a case of a mass located in the L5 lumbar spine in a 42 year old man, presented with intermittent lumbar pain. Ultrasound, CT and MRI were used to examine the characteristics of the lesion. Fine needle aspiration showed cytologic characteristics of benign schwannoma and final histological diagnosis was ancient schwannoma. An extraperitoneal approach, through a left paramedian incision was used to approach the site of the mass. The lesion originated from the nerve root of the L4-L5 lumbar spinal space and a complete excision was achieved.ConclusionA great variety of tumors should be differentiated when a paraspinal mass is discovered, including neurogenic, neuroendocrine and vascular tumors, as well as malignancies, cystic and inflammatory masses. Fine needle aspiration is a useful and reliable tool in the preoperative evaluation of paraspinal masses. A review of the literature is also presented.
Highlights
Schwannomas are rare encapsulated tumors that derive from the nerve sheath and should be removed due to their infrequent, but existent possibility of malignancy.Case presentation: We report a case of a mass located in the L5 lumbar spine in a 42 year old man, presented with intermittent lumbar pain
Preoperative biopsy or fine needle aspiration (FNA) may be very useful, only the final histological examination can definitively establish the real nature of the lesion
The mass was surgically removed and the final histology revealed ancient schwannoma of the lumbar spine, a diagnosis that was suggested by preoperative FNA
Summary
It is evident that paraspinal lumbar region can be the source of heterogeneous lesions that extend from the most benign to the most aggressive tumor. It is a necessity for the surgeon to fully understand their pathology, in order to be very comfortable when selecting http://www.casesjournal.com/content/2/1/9325 the optimal treatment. The role of preoperative biopsy is highlighted in several studies and is thought to be essential so as to orientate therapy, determine the operative strategy and avoid overtreatment and major complication. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review from the journal's Editor-in-Chief
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