PMC6069368_01
MRI cervical spine suggestive of (a) T1 hypointense (b) T2 heterogeneously hyperintense solid - cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord and pushing it anteriorly and to the right. (c) The lesion shows heterogeneous post contrast enhancement.
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F1
T2, a heterogeneously hyperintense solid-cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord; that heterogeneously enhanced with contrast [Figure 1]. The same day the patient acutely developed severe neck pain and an acute spastic quadriparesis (power was 2/5 in all 4 limbs; C5 sensory level). The patient immediately underwent a partial C2, C3, and C4 laminectomy for tumor excision; the IDEM mass exhibited intratumoral hemorrhage [Figure 2].
(a) Intra-operative photograph showing cervical schwannoma with intratumoral bleed. (b) The lesion is causing severe compression of the spinal cord
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F2
T2, a heterogeneously hyperintense solid-cystic intradural extramedullary (IDEM) C2 to C4 mass severely compressing the spinal cord; that heterogeneously enhanced with contrast [Figure 1]. The same day the patient acutely developed severe neck pain and an acute spastic quadriparesis (power was 2/5 in all 4 limbs; C5 sensory level). The patient immediately underwent a partial C2, C3, and C4 laminectomy for tumor excision; the IDEM mass exhibited intratumoral hemorrhage [Figure 2].
(a) Hematoxylin and eosin 40x magnification: Low power view of the tumor showing numerous congested and dilated blood vessels. (b) Hematoxylin and eosin 200x magnification: Both hypocellular and hypercellular areas of schwanomma seen with the hypercellular areas showing the tumour to be composed of spindle cells. (c and d) S100 staining, 100x and 200x magnification respectively: S100 stain at low and high power respectively showing cytoplasmic positivity in tumour cells proving the neuronal origin of the cells
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F3
Immunohistochemistry was also positive for S100 protein, leading to the final histopathological diagnosis of "schwannoma showing areas of congestion and hemorrhage" [Figure 3].