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An interesting case of peripheral nerve sheath tumour presenting with acute onset progressive quadriparesis
Poster Title: An interesting case of peripheral nerve sheath tumour presenting with acute onset progressive quadriparesis
Submitted on 23 Sep 2019
Author(s): Sumit Kumar, Prateek Luthra, Rahul Dev
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Abstract: INTRODUCTION: Peripheral nerve cervical root neurofibromas represents an important clinical problem. Peripheral nerve sheath tumors have been divided into benign and malignant types.
Transforaminal schwannomas are more commonly seen than neurofibromas at cervico-vertebral junction along lower cervical nerve roots.

OBJECTIVE: Differentiating the peripheral nerve sheath tumors on magnetic resonance imaging.

MATERIAL AND METHOD: A 45year old male who presented with pain in the neck for 4 weeks and progressive quadriplegia for 3weeks with bowel/bladder incontinence for 3days. Conventional radiographs, non- contrast Computed Tomography with 64 slices, CEMRI at 3T and histopathological correlation with immunohistochemistry were done to make the final diagnosis.

RESULTS: Eccentric, fusiform, dumbbell-shaped, T2 hyperintense lesion which is all around surrounded by the CSF is seen at transforaminal C5-C6 neural foraminal level on right side suggestive of extradural and intramedullary compartment origin. Imaging diagnosis of benign peripheral nerve sheath tumor was made. Histopathological findings were favoring both neurofibroma and schwannoma. Immunohistochemistry staining with S-100 was negative, so the diagnosis of neurofibroma was made. The patient was operated and the tumor was excised. The postoperative scan was suggestive of complete excision and patient symptoms improved significantly.

CONCLUSION: MR imaging is a non-invasive modality that can differentiate between the benign and malignant nerve sheath tumors by various imaging characteristics and the pathognomic signs but sometimes it is not so. Histopathology and Immunohistochemistry can help in these cases. MRI can also provide precise roadmap and information for 3D model printing which helps the surgeons for their intricate surgeries and reduces the intraoperative complications significantly.
Summary: Peripheral and malignant peripheral nerve sheath tumors can be differentiated on MR imaging but sometimes, the imagings are not pathognomic, so histopathology with immunohistochemistry play a major role in diagnosing these cases. References: 1.Exhibit, E. Costanzo, V. Belfiore, G. Granata, G. Milone, P. Ruggieri, M. Palmucci, S. (2018). Malignant Peripheral Nerve Sheath Tumors ( MPNSTs ): clinical features and radiologic-pathologic correlation, 1–19.
2.Kakkar, C. Shetty, C. M. Koteshwara, P. & Bajpai, S. (2015). Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging, 25(4), 5-10.
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