PMC5331155_01
Firm and well-circumscribed left lower back cutaneous schwannoma with superficial skin changes (black arrow).
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However, there were superficial skin changes overlying the mass (Fig. 1).
H&E low power field showing a well-delineated and circumscribed cellular lesion.
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Histological examination from the incisional biopsy showed a well-delineated and circumscribed cellular lesion (Fig. 2) comprised of bland spindled cells with a neural appearance (Fig. 3).
H&E medium power field showing highly cellular palisaded Antoni A regions (black arrow) and loosely-arranged Antoni B regions (red arrow).
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The lesion had variable cellularity, including Antoni A and B areas (Fig. 4).
H&E high power field showing bland spindled cells with no increased mitosis or cellular atypia.
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There was minimal nuclear pleomorphism and no increase in mitosis (Fig. 5).
MRI coronal view showing the cutaneous schwannoma at the level of the L3 and L4 vertebral bodies to the left of midline.
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Imaging showed a heterogeneously enhancing mass located in the posterior subcutaneous soft tissue superficial to the paraspinal musculature at the level of the L3 and L4 vertebral bodies to the left of midline (Fig. 6, Fig. 7).
Intra-operative lateral view of the left lower back cutaneous schwannoma.
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The patient then underwent wide local excision of the cutaneous schwannoma with radical resection down to the thoracolumbar fascia under general anesthesia (Fig. 8).
Post-operative anterior view of the left lower back cutaneous schwannoma.
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Once removed, the tumor measured 8 x 6.5 x 2.5 cm (Fig. 9, Fig. 10) and was again consistent with the original diagnosis on final pathology.