PMC4138822_01
Contrast-enhanced axial computed tomography scan showing hypodense, enhancing lesion in the left L5-S1 neural foramen
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F1
Computed tomography (CT) scan carried out revealed a hypodense, enhancing lesion in the left L5-S1 neural foramen with the widening of the foramen and "scalloping" of the posterior vertebral surface [Figure 1].
MRI showing a round lesion in the L5-S1 neural foramen arising from the left S1 nerve root, hypointense on T1, and hyperintense on T2, with a peripheral ring enhancement after gadolinium injection suggesting a schwannoma
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F2
T2, with a peripheral ring enhancement after gadolinium injection. These features suggested a schwannoma. The rest of the disco-vertebral structures were intact [Figure 2].
Pathological examination showing the tumor consists of spindle cell proliferation with compact hypercellular areas and myxoid hypocellular areas. Cells are narrow, elongate, and wavy with tapered ends interspersed with collagen fibers without evidence of mitosis. Nuclear palisading around fibrillary process is often seen in cellular areas; large irregularly spaced vessels are most prominent and gaping tortuous lumina have thickened hyalinized walls
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Histological examination of the excised tissue suggested a benign schwannoma [Figure 3].
One-month postoperative MRI shows a left L5 laminectomy, left-sided foraminotomy, with total resection of the schwannoma
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One-month postoperative MRI showed total resection of the schwannoma [Figure 4].