Liu Congcong, Yan Lianqi, Liu Qing, Li Jing, Jin Hongtao, Wang Jingcheng, Deng Youwen
Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan.
Department of Orthopedics, Clinical medical college of Yangzhou University.
Medicine (Baltimore). 2018 Sep;97(39):e12474. doi: 10.1097/MD.0000000000012474.
Microcystic/reticular schwannoma (MRS) is a rare histological variant of schwannoma which was initially described in 2008 with a predilection for the visceral organs. This distinct tumor had been reported to mainly affect gastrointestinal tract, subcutaneous and soft tissue, various glands and head and neck region. However, MRS involving spine is extremely rare.
The authors report the first case of MRS occurring in the lumbar (L) spinal canal of a 40-year-old male who presented with continuous pain and numbness in both feet for 2.5 years. Physical examination revealed weakness of lower extremities and hyperalgesia of both feet.
The findings of pre-operative investigation were suspicious for either a schwannoma or a spinal meningioma. Accordingly, total laminectomy, complete tumor resection, instrumentation and spinal fusion were performed. Post-operative histopathologic examination revealed a well-encapsulated neoplasm with reticular and microcystic growth pattern. Antoni A and Antoni B regions, Verocay bodies and hyalinized blood vessels were observed. And cytologic atypia, necrosis or mitosis was absent. Immunohistochemically, the tumor cells showed strong and diffuse positivity for S-100 as well as SOX 10. Therefore, a histopathological diagnosis of MRS was finally made.
The patient remains well with no evidence of recurrence at a 22-month follow-up.
This is the first case of MRS which is located in the L spinal canal. Awareness of this distinctive entity is helpful in preventing diagnostic pitfalls and making correct treatment strategies.
微囊性/网状神经鞘瘤（MRS）是神经鞘瘤一种罕见的组织学变异类型，最初于2008年被描述，好发于内脏器官。据报道，这种独特的肿瘤主要累及胃肠道、皮下及软组织、各种腺体以及头颈部区域。然而，累及脊柱的MRS极为罕见。
作者报告了首例发生在一名40岁男性腰椎管内的MRS病例，该患者双足持续疼痛和麻木2.5年。体格检查发现下肢无力及双足痛觉过敏。
术前检查结果怀疑为神经鞘瘤或脊膜瘤。因此，实施了全椎板切除术、肿瘤全切术、内固定及脊柱融合术。术后组织病理学检查显示肿瘤包膜完整，呈网状和微囊性生长模式。可见Antoni A区和Antoni B区、Verocay小体及玻璃样变血管。未见细胞异型性、坏死或核分裂象。免疫组化显示，肿瘤细胞S-100及SOX 10呈强弥漫阳性。因此，最终做出MRS的组织病理学诊断。
患者恢复良好，22个月随访无复发迹象。
这是首例位于腰椎管内的MRS病例。认识这种独特的疾病有助于避免诊断陷阱并制定正确的治疗策略。
