Dumbbell Schwannoma Research Articles

A Case Report of Chondrosarcoma That Primarily Developed in the Cervical Spine

Dear Editor, Hereby, we will report a rare case of cervical spine chondrosarcoma producing a dumbbell shape foraminal mass lesion. Generally, spinal neural foraminal widening has several causes. They may be tumoral such as neurogenic tumors, developmental or vascular. Occasionally spinal neural foraminal widening is in the shape of a dumbbell lesion. In this case, the differential diagnosis is limited but a little more different. Neurogenic tumors (schwannoma and neurofibroma) are the most common. At times some other slow-growing tumors may cause dumbbell-shaped neural foraminal widening. Other slow-growing tumors such as chordomas, ependymomas and meningiomas may every so often cause neural foraminal widening [1]. A case report of dumbbell-shaped lymphangioma, a case report of dumbbell-shaped chordoma and another case of lipoma have also been documented [2][3][4]. We report a patient with a spinal chondrosarcoma passing through the C4-C5 foramen, a dumbbell chondrosarcoma representing a rare condition. This rare case has significant importance because it makes the radiologist think of a wider differential diagnoses of a dumbbell-shaped spinal lesion including those from the bone origin than simply neurogenic tumors and to get familiar with imaging aspects of such a condition. Primary chondrosarcoma occurs mainly between the ages of 30 and 70 years. Although our patient is in this range, he seems to be a little young for chondrosarcoma. In the literature review, there is only one reported case of dumbbell-shaped chondrosarcoma in the cervical spine. However, the article has less focus on the imaging aspects of the tumor [2]. A 36-year-old man presented with progressive pain of left-sided upper limb for over 3 years. The pain began 3 years ago and had aggravated during the last 6 months. In his physical examination, the pain did not have a radicular characteristic. Reflexes and muscle forces were in the normal limit. The pain slightly got worse at night. Magnetic resonance imaging (MRI) of the cervical spinal column with 1.5 Tesla magnet on T1-weighted (TR = 700.0 and TE = 12.0) and T2-weighted (TR = 3520.0 and TE = 95) sequences without contrast material reveals a lobulated dumbbell-shaped soft tissue mass with a regular border originated from the neural arcus of the fifth cervical vertebra extending to the right-sided C4-C5 neural foramina. It has low to intermediate signal intensity on T1-weighted axial (Figure 1A) and coronal (Figure 1B) images and high signal intensity on T2-weighted axial (Figure 1C) and T2- weighted coronal images (Figure 1D and ​andEE). Figure 1 Magnetic resonance imaging of the cervical spinal column with 1.5 Tesla magnet on T1-weighted and T2-weighted sequences with contrast material reveals a lobulated dumbbell-shaped soft tissue mass with regular border originated from the neural arcus of ... At surgery, the anterior part of the neck was approached through the sternocleidomastoid muscle. Deep to the muscle, there was a firm and hemorrhagic carpet-like expanded mass. It was too difficult to resect the whole tumor; so it was partially resected. Inside the mass was softer and more resectable. The family history and a skeletal survey of the patient did not reveal any other lesion. The pathologic study of the specimen with H & E staining and on high power view showed thin anastomosing strands of tumor cells surrounded by an abundant myxoid matrix indicating a chondrosarcoma (Figure 2). Figure 2 Thin anastomosing strands of tumor cells surrounded by an abundant myxoid matrix (high power view) on H & E staining indicating a chondrosarcoma. Dumbbell tumor of the spine is not uncommon. Spinal neural foraminal widening may be due to neoplasm, arterial abnormalities or developmental causes [5][6][7]. The most common cause is the so-called dumbbell schwannoma or neurofibroma. In the spine, a lesion with combined intradural and extradural components may lead to the so-called dumbbell mass, which passes through the corresponding neural foramen. The most common causes of spinal dumbbell lesions are schwannomas and neurofibromas, while other nerve sheath tumors, ganglioneuromas and neurofibrosarcomas are rare. Conjoined nerve roots, root sleeve cysts, ganglion cysts and foraminal disc herniations are relatively common conditions which can resemble nerve sheath tumors. Rare causes include aneurysm, looping or tortuosity of the vertebral artery, a developmental condition associated with absence of vertebral pedicle and resultant widening and craniocaudal elongation of the neural foramen and a dumbbell-shaped lipoma. The MRI characteristics such as signal intensity on various sequences and the pattern of enhancement in association with large paraspinal soft tissue mass suggest a sarcomatous change. The most common site of chondrosarcoma is the pelvis and ribs. However, spinal column is an occasional site [7]. The prognosis of chondrosarcoma is relatively good if complete surgical excision is possible before dissemination. Metastasis only occurs in later stages by the hematogeneous route. In our patient, no metastatic site was documented [7].

Giant dumbbell tumor of the posterior mediastinum

Giant dumbbell-shaped tumors are very rare and characterized by intra- and extraspinal propagation of different dimensions. In thoracal localization, invasive growth can lead up to rib and vertebra erosion. We presented a 54-year-old woman with a giant dumbbell schwannoma in the posterior mediastinum. The tumor was removed by the posterior approach with hemilaminectomy and costotransversectomy. By microscopic examination the diagnosis of benign schwannoma was made. A year after the surgery, the patient was without neurological deficiency and without radiological signs of illness relapse. Treatment of dumbbell schwannoma is surgical, dilemmas of the optimal surgical approach. When it is thoracally located the posterior approach with hemilaminectomy and costotransversectomy is safe and effective for its removal.

Modified posterior unilateral laminectomy for a complex dumbbell schwannoma of the thoracolumbar junction

We report on an uncommon type of complex dumbbell schwannoma involving the thoracolumbar region, which was successfully managed with unilateral hemilaminectomy using a modified posterior approach. A 19-year-old male patient presented with one-year history of low back pain radiating to the lower limbs, limping of two month-history, and hesitancy of micturition of 15-day duration. Clinically, a diagnosis of conus-cauda lesion was suspected. Findings of the X-ray and magnetic resonance imaging of the dorsolumbar spine were suggestive of a complex dumbbell schwannoma, extending from the lower part of the T11 level to the upper part of the L1 vertebrae left to the spinal cord, with extension through the intervertebral foramina to the paraspinal region on the left side. A modified posterior approach with unilateral laminectomy was used for complete removal of the tumor. The histological diagnosis was schwannoma. The patient had minimal pain postoperatively, he was mobilized on the third day without the need for any external support. At one year follow-up, he had normal motor and sensory functions in the lower limbs.

Extradural dumbbell schwannoma of the hypoglossal nerve: a case report with review of the literature

Background Dumbbell-shaped schwannomas of the hypoglossal nerve are very rare. This report concerns a case with an extradural, dumbbell-shaped hypoglossal schwannoma extending both intra- and extracranially. Case Description A 25-year-old woman presented with a right hypoglossal palsy. Imaging revealed a dumbbell-shaped tumor with considerable compression and medial displacement of the medulla oblongata, diagnosed as a hypoglossal schwannoma. The tumor mass extended extracranially to the parapharyngeal space through the enlarged hypoglossal canal. The tumor was partially excised by a right far-lateral suboccipital approach and the tumor was found to be predominantly extradural with minimal intradural extension. A histopathologic diagnosis of schwannoma was made. Conclusions This case emphasizes the importance of recognizing this extradural variant of schwannoma. Staged extracranial and intracranial approaches to these tumors may be necessary.

Single stage complete excision of large thoracic dumbbell schwannoma by modified posterior approach

Background Dumbbell-shaped thoracic neurinomas represent a distinct type of tumor and can involve both the spinal canal and the posterior thoracic cavity. Successful management of posterior mediastinal dumbbell tumors depends on complete resection with adequate exposure. Case Description A 40-year-old woman presented with history of progressive weakness of both lower limbs for 5 months and was bedridden for the last 23 days. Magnetic resonance imaging showed a dumbbell-shaped lesion at the D-6 level, extending through the intervertebral foramen between the D-6 and D-7. Through an elliptical incision on the right side of the D-6, hemilaminectomy was performed, and in addition, resection of the transverse processes of the D-6 and D-7 was performed to gain wide exposure. After initial internal decompression, tumor could be removed completely. Conclusions The present method was easy to perform, secure, and less invasive, and was well tolerated by the patient.

Dorsal dumb-bell melanotic schwannoma operated on by posterior and anterior approach: case report and a review of the literature

The schwannomas are benign tumors originating from Schwann cells which constitute the nerve sheath. The dorsal pigmented type of schwannomas is relatively rare (Goldstein in Am J Med Genet 86:62–65, 2004; Kurtkaya-Yapicier in Histol Histopathol 18(3):925–934, 2003). There are two distinct types of melanotic schwannoma: the sporadic melanotic schwannomas and the psammomatous melanotic schwannomas of Carney complex. We report a case of a patient harboring a right dorsal dumb-bell melanotic schwannoma and left adrenal mass. The patient underwent a surgical procedure for en bloc total removal of the mass by a posterior and anterior approach. Histopathological examination revealed the diagnosis of melanotic schwannoma. At present, we have no reliable marker of histopathological malignancy of melanotic schwannoma so the follow-up period ought to continue for a period of more than 5 years. As the total removal of the melanotic neurinomas is mandatory to prevent possible malignant transformation of the tumor recurrence or regrowth, we believe that the posterior and trans-thoracic approach are the most suitable one for the dorsal dumb-bell schwannoma.

Cervical dumbbell meningioma and thoracic dumbbell schwannoma in a patient with neurofibromatosis

The occurrence of both dumbbell meningioma and dumbbell schwannoma in one patient has not been reported in the literature. We present a 16-year-old female patient, who had progressive bilateral hearing impairment for 5 years and a progressively enlarged, non-tender neck mass for 1.5 years. Mild motor weakness over her right upper limb was noted 1 week before admission. No café-au-lait spot was noted. Magnetic resonance imaging (MRI) revealed bilateral cerebellopontine angle tumors, a C1-2 dumbbell tumor, and a T5-6 dumbbell tumor. Neurofibromatosis type 2 was diagnosed. The cervical spine and thoracic spine tumors were removed via one-staged combined posterior (laminectomy) and antero-lateral (transforaminal or thoracoscopic) approaches during two operations performed 1 month apart. The pathology revealed meningioma and schwannoma, respectively. The patient had good recovery after these two operations and her motor function improved. Six months after the second surgery, radiosurgery was performed for the bilateral acoustic tumors, because of enlarged tumor size on follow-up MRI. To the best of our knowledge, this is the first case reported in the literature of a patient, having both dumbbell meningioma and dumbbell schwannoma. A literature review of the dumbbell tumors was done, and their treatment strategies were discussed.

Congenital intra-extracranial dumbbell schwannoma of temporal fossa unassociated with any major cranial nerve

Intracranial schwannomas commonly arise from the vestibular nerve and less commonly from other cranial nerves. On rare occasions, they may be intraparenchymatous, intraventricularor intrasellar. However, the occurrence of a congenital solitary intracran ial extradural schwannoma unrelated to any cranial nerve in the absence of von Recklinghausan's syndrome is exceptional. The authors report a unique, heretofore unreported case of a congenital temporal extradural schwannoma, unassociated with any known c ranial nerve and with a transcranial extension presenting as a temporal fossa mass since birth in a 16-year-old female patient. Total resection of this tumour was uncomplicated. A brief review of therelevant literature is presented.

O-16-231 - Epidural buprenorphine for relieving postoperative pain in patients undergoing lumbar laminectomy: A preliminary study

It is rare for 2 primary tumors to occur simultaneously in a patient. Management of cervical dumbbell schwannomas (CDSs) with concurrent tumors (CTs) requires a specific neurosurgical strategy. The primary objective of this study is to investigate surgical strategies for CDSs with CTs while preserving as much of the mechanically relevant bone structures as possible.Twelve patients with concurrent CTs and CDSs were identified from 3 medical centers. Surgical strategies for CDSs were based on accurate preoperative images and subsequent treatment considerations for CTs. All patients received surgical treatment for CDSs and CTs. Clinical features, surgical considerations for a transforaminal approach (TA), and ultimate outcome were studied retrospectively.Gross total resection of CDSs was achieved with endoscopic and microscopic assistance in 9 cases, and subtotal resection was achieved in 3 cases after the head and neck surgeons exposed and removed the extraforaminal anatomy. One patient required an additional hemilaminectomy for the resection of the intraspinal segment. After wound healing, patients were transferred to the appropriate surgical department for surgery on CTs with cervical spine stabilization after a transforaminal approach.In most patients, the stability of the cervical spine can be preserved with low invasive microsurgical or endoscopic transforaminal resection. CTs could be surgically treated sequentially after microscopic- and endoscopic-assisted resection of CDSs.