Abstract
Objectives
We report a case of paraspinal ancient schwannoma located at the upper thoracic level that mimicked an atypical lipoma or complicated epidermoid cyst.
Summary of Literature Review
Few case reports of paraspinal schwannoma have been reported and the incidence of ancient schwannoma in the paraspinal muscle layer is very rare.
Materials and Methods
A 39-year-old man complained of a growing palpable back mass for 5 years. He experienced aggravated chronic discomfort around the mass while lying down. Both T1- and T2- weighted magnetic resonance imaging (MRI) showed a well-capsuled and heterogeneous high-signal mass in the muscle layer at the level from the T1 to T4 vertebral bodies on the right side of the midline. The tumor was completely removed by en bloc resection.
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Fig. 1.
Magnetic resonance imaging showing (A) a well-defined, irregular thick-walled cystic lesion and (B) central non-enhancement with peripheral irregular heterogeneous enhancement.
![jkss-26-111f1.tif](/upload/SynapseXML/1089jkss/thumb/jkss-26-111f1.gif)
Fig. 2.
The excised mass. (A) The mass was solitary, well circumscribed, and capsulated. It presented yellow-to-gray coloration, myxoid and soft stromal areas, and multiple tan/brown hemorrhagic foci. (B) On a cut section, cystic changes were more evident.
![jkss-26-111f2.tif](/upload/SynapseXML/1089jkss/thumb/jkss-26-111f2.gif)
Fig. 3.
Microscopic images showing (A) a hypocellular area in the central region (white arrow) and a more cellular area in the peripheral region (black arrow), but less cellular than a typical schwannoma (hematoxylin and eosin [H&E], ×40). Both hyaline vascular changes (white arrow) and thrombi (black arrow) were present (H&E, ×100). (C) The typical Antoni A area was not identified; instead, only a vague Antoni A–like area was identified in this case (H&E, ×200). (D) Cellular features included bizarre nuclei (H&E, ×400).
![jkss-26-111f3.tif](/upload/SynapseXML/1089jkss/thumb/jkss-26-111f3.gif)