Malignant Nerve Sheath Tumor with Secondary Intradural Extramedullary Metastases

Abstract

We present a case of a 65 year old male patient of a malignant nerve sheath tumor with multiple intradural, extra medullary metastases and its preoperative imaging on MRI. Patient presented with complaints of pricking type of pain the cervical and dorsolumbar region since one year which was progressive since the day of onset of the symptoms. Introduction Nerve sheath tumors account for 80 to 90 % of all intradural extramedullary neoplasms 1 . Two main types of nerve sheath tumors are found in the spine: schwannoma (also known as neurinoma or neurilemoma) and neurofibroma. Schwannomas are lobulated, grossly encapsulated, well circumscribed round or oval tumors that often show cystic degeneration, hemorrhage and xanthomatous changes. Schwannomas arise eccentrically from their parent nerve; primary malignant peripheral nerve sheath tumors occur but are very rare 2 . Schwannomasal most never become malignant whereas sarcomatous transformation occurs in 4% to 11%of patients with neurofibromatosis 3. Case Presentation A 65 year old male patient presented to outpatient department of orthopedic complaining of a pricking type of pain in the cervical and dorso lumbar region since one year and was progressive since the day of onset of the symptoms. Physical examination demonstrated loss of patient strength of the right arm with restriction of movements. The patient was referred to the department of Radio-diagnosis for imaging workup, An MRI Study of the cervical spine was requested, imaging was conducted using 1.5 Tesla Siemens MR Machine. Axial GRE, sagittalT1W and T2W sequences were taken at the level of the cervical spine with screening of the brain and whole spine. MRI of the cervical spine revealed two intradural extramedullary lesions, the larger lesion was well defined which was present at the level of the foramen magnum, closely adherent to the brain stem. The lesion was indenting cerebellar tonsils with outaltered signal intensities in the basion, ophisthion and the posterior elements. Another lesion was noticed at the level of C6 & C7 vertebral bodies, the lesion was well defined and www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i4.13